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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

DR. NATHAN VICKNAIR STUDENT
NPI 1376171298
Internal Medicine - Gastroenterology in Pueblo, CO

Active since March 27, 2020PECOS Enrolled
400 W 16TH ST, PUEBLO, CO 81003(719) 584-4000 Get Directions Write a Review

NPPES record last updated: August 6, 2026. Verified against the NPPES registry weekly; last sync: September 13, 2026.

Record update history: Aug 6, 2026, Mar 27, 2020 (2 updates tracked since 2020).

About Dr. Nathan Vicknair Student NPPES

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

DR. NATHAN VICKNAIR STUDENT (NPI 1376171298) is an individual gastroenterology provider in Pueblo, Colorado, licensed in Louisiana (352219) and active in the NPI registry since March 2020. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1376171298
Entity TypeIndividualMale
Primary Taxonomy207RG0100X
Provider Legal NameDR. NATHAN VICKNAIRCredential: STUDENT
Location Address400 W 16TH STPueblo, CO 81003-2745
Mailing Address216 W 10th Ave Ste 202Kennewick, WA 99336-6304 · (509) 221-5510
Phone(719) 584-4000
Sole ProprietorNo
Enumeration DateMarch 27, 2020
Last NPPES UpdateAugust 6, 20262 updates tracked since enumeration
NPPES CertifiedAugust 6, 2026
✔ NPI 1376171298 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · GastroenterologyAllopathic & Osteopathic Physicians
Taxonomy Code207RG0100X
License✔ Licensed in LA · 352219
Definition
An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs.
400 W 16TH ST, Pueblo, CO 81003
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Nathan Vicknair Student is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 81003 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$132.55 typical visit price
range $58.06 – $174.82
Typical copayment $33.13 (range $14.51 – $43.70)
Most-billed visit code 99204
Established Patient
$102.03 typical visit price
range $18.88 – $142.79
Typical copayment $25.50 (range $4.72 – $35.69)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

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

MISS EMILY ANNE KEARNEY RDN
Dietitian, Registered
400 W 16TH ST
PUEBLO, CO 81003
Pueblo County (719) 584-4994
CHRISTOPHER JON STARK
Internal Medicine
400 W 16TH ST
PUEBLO, CO 81003
Pueblo County (719) 595-2218
MARY RUSSO DO
Emergency Medicine
400 W 16TH ST
PUEBLO, CO 81003
Pueblo County (719) 584-4306
DR. DARYA BLEDNOVA MD
Internal Medicine
400 W 16TH ST
PUEBLO, CO 81003
Pueblo County (970) 624-2403
LARA KJURSTON KNOWLES CRNA
Nurse Anesthetist, Certified Registered
400 W 16TH ST
PUEBLO, CO 81003
Pueblo County (719) 584-4000
KAYLA TOENNIS DO
Internal Medicine
400 W 16TH ST
PUEBLO, CO 81003
Pueblo County (719) 595-7585
DR. SHAUN MICHAEL PITTS DO
Internal Medicine
400 W 16TH ST
PUEBLO, CO 81003
Pueblo County (719) 595-7585
JAMIE YI
Nurse Anesthetist, Certified Registered
400 W 16TH ST
PUEBLO, CO 81003
Pueblo County (719) 584-4000

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 Nathan Vicknair's NPI number?

The NPI number for Nathan Vicknair is 1376171298. It was assigned to this individual provider in the NPPES registry on March 27, 2020.

Where is Nathan Vicknair located?

Nathan Vicknair practices at 400 W 16th St, Pueblo, CO 81003. The listed phone number is (719) 584-4000.

What is Nathan Vicknair's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Gastroenterology, with taxonomy code 207RG0100X.

Is Nathan Vicknair enrolled in Medicare?

Yes. Nathan Vicknair is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Nathan Vicknair was last updated on August 6, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 45 days 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.