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MRS. KIMBERLY RUTH NICOLSON DSW, LCSW
NPI 1164617015
Social Worker in Redondo Beach, CA

Active since September 12, 2007PECOS EnrolledAccepts Medicare Assignment
1840 S ELENA AVE STE 106, REDONDO BEACH, CA 90277(310) 737-2210 Get Directions Write a Review

NPPES record last updated: December 26, 2024. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Dec 26, 2024, Apr 4, 2022 (2 updates tracked since 2022).

About Mrs. Kimberly Ruth Nicolson Dsw, Lcsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. KIMBERLY RUTH NICOLSON DSW, LCSW (NPI 1164617015) is an individual social worker in Redondo Beach, California and active in the NPI registry since September 2007. She is enrolled in Medicare PECOS and is a graduate of Other (2008).

NPPES Registry Identity

NPI1164617015
Entity TypeIndividualFemale
Primary Taxonomy104100000X
Provider Legal NameMRS. KIMBERLY RUTH NICOLSONCredential: DSW, LCSW
Location Address1840 S ELENA AVE STE 106Redondo Beach, CA 90277-5716
Mailing Address1840 S Elena Ave Ste 106Redondo Beach, CA 90277-5716 · (310) 737-2210
Phone(310) 737-2210
Sole ProprietorNo
Medical School CMSOtherGraduated 2008
Enumeration DateSeptember 12, 2007
Last NPPES UpdateDecember 26, 20242 updates tracked since enumeration
NPPES CertifiedDecember 26, 2024
✔ NPI 1164617015 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySocial WorkerBehavioral Health & Social Service Providers
Taxonomy Code104100000X
Definition
A social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public.
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X · License 62673 (CA)
1840 S ELENA AVE STE 106, Redondo Beach, CA 90277
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Other Names 1

Former Name (1)Kimberly Ruth Ives

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mrs. Kimberly Ruth Nicolson Dsw, Lcsw is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2860867629
PECOS Enrollment IDI20230407001779
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Kimberly Nicolson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Mineset Mental Health Inc.
Same address
Mental Health (Including Community Mental Health Center)
1840 S ELENA AVE STE 106
Redondo Beach, CA 90277
  • Reassigned Medicare billing, California enrollment
NPI 1972284669 (310) 737-2210

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MINESET MENTAL HEALTH INC.
Clinic/Center (Mental Health (Including Community Mental Health Center))
1840 S ELENA AVE STE 106
REDONDO BEACH, CA 90277
Los Angeles County (310) 737-2210

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kimberly Nicolson's NPI number?

The NPI number for Kimberly Nicolson is 1164617015. It was assigned to this individual provider in the NPPES registry on September 12, 2007. The provider is also known as Kimberly Ruth Ives.

Where is Kimberly Nicolson located?

Kimberly Nicolson practices at 1840 S Elena Ave Ste 106, Redondo Beach, CA 90277. The listed phone number is (310) 737-2210.

What is Kimberly Nicolson's specialty?

The primary specialty registered for this NPI is Social Worker with taxonomy code 104100000X.

Is Kimberly Nicolson enrolled in Medicare?

Yes. Kimberly Nicolson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Kimberly Nicolson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kimberly Nicolson reassigns Medicare benefits to Mineset Mental Health Inc. (Redondo Beach, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kimberly Nicolson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Kimberly Nicolson was last updated on December 26, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.