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DR. MICHAEL TYSEN NICKLE DO
NPI 1417525601
Family Medicine in Pueblo, CO

Active since June 14, 2021PECOS EnrolledAccepts Medicare Assignment
902 LAKEVIEW AVE, PUEBLO, CO 81004(719) 557-5872(719) 557-4780 Get Directions Write a Review

NPPES record last updated: June 29, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jun 29, 2021, Jun 14, 2021 (2 updates tracked since 2021).

About Dr. Michael Tysen Nickle Do NPPES

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

DR. MICHAEL TYSEN NICKLE DO (NPI 1417525601) is an individual family medicine provider in Pueblo, Colorado, licensed in Colorado (TL.0009001) and active in the NPI registry since June 2021. He is enrolled in Medicare PECOS and is a graduate of Rocky Vista University College Of Osteopathic Med (2021).

NPPES Registry Identity

NPI1417525601
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameDR. MICHAEL TYSEN NICKLECredential: DO
Location Address902 LAKEVIEW AVEPueblo, CO 81004-3597
Mailing Address902 Lakeview AvePueblo, CO 81004-3597 · (719) 557-5872 · Fax (719) 557-4780
Phone(719) 557-5872
Fax(719) 557-4780
Sole ProprietorNo
Medical School CMSRocky Vista University College Of Osteopathic MedGraduated 2021
Enumeration DateJune 14, 2021
Last NPPES UpdateJune 29, 20212 updates tracked since enumeration
NPPES CertifiedJune 29, 2021
✔ NPI 1417525601 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in CO · TL.0009001
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X · License TL.0009001 (CO)
902 LAKEVIEW AVE, Pueblo, CO 81004
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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

Dr. Michael Tysen Nickle Do 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 ID941602585
PECOS Enrollment IDI20240803000118
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 Reassignments

2

Medicare enrollment records show Michael Nickle reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Valley-Wide Health Systems, Inc
87 mi
Federally Qualified Health Center (FQHC)
128 MARKET STREET
Alamosa, CO 81101
  • Reassigned Medicare billing, Colorado enrollment
  • 51 clinicians in this Medicare group
NPI 1790998953 (719) 587-1139
Rocky Vista Health Center LLC
92 mi
Family Medicine
8401 S CHAMBERS RD
Englewood, CO 80112
  • Reassigned Medicare billing, Colorado enrollment
  • 14 clinicians in this Medicare group
NPI 1366606709 (720) 875-2880

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 81004 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
$89.43 typical visit price
range $58.06 – $174.82
Typical copayment $22.35 (range $14.51 – $43.70)
Most-billed visit code 99203
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.

DR. CAMILA TERESA ROBLES DO
Family Medicine
902 LAKEVIEW AVE
PUEBLO, CO 81004
Pueblo County (719) 557-5872
MARK DAVIS PA-C
Physician Assistant
902 LAKEVIEW AVE
PUEBLO, CO 81004
Pueblo County (719) 557-5855
MADISON BASSETT
Student in an Organized Health Care Education/Training Program
902 LAKEVIEW AVE
PUEBLO, CO 81004
Pueblo County (719) 557-5855
REBECKA ANN REATHERFORD AGACNP-BC
Nurse Practitioner (Acute Care)
902 LAKEVIEW AVE
PUEBLO, CO 81004
Pueblo County (719) 557-5855
LUCINEI GERALDO STADNIK MD
Student in an Organized Health Care Education/Training Program
902 LAKEVIEW AVE
PUEBLO, CO 81004
Pueblo County (719) 557-5872
DR. LISA HAMILTON MD
Student in an Organized Health Care Education/Training Program
902 LAKEVIEW AVE
PUEBLO, CO 81004
Pueblo County (719) 557-5872
TIFFANY ANNE GARCIA FNP
Nurse Practitioner (Family)
902 LAKEVIEW AVE
PUEBLO, CO 81004
Pueblo County (719) 557-5855
DR. KIMBERLEY EVELYN JACKSON D.O.
General Practice
902 LAKEVIEW AVE
PUEBLO, CO 81004
Pueblo County (719) 557-5855

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 Michael Nickle's NPI number?

The NPI number for Michael Nickle is 1417525601. It was assigned to this individual provider in the NPPES registry on June 14, 2021.

Where is Michael Nickle located?

Michael Nickle practices at 902 Lakeview Ave, Pueblo, CO 81004. The listed phone number is (719) 557-5872.

What is Michael Nickle's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Michael Nickle enrolled in Medicare?

Yes. Michael Nickle 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 organizations bill Medicare for Michael Nickle's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Michael Nickle reassigns Medicare benefits to 2 organizations: Valley-Wide Health Systems, Inc (Alamosa, CO) and Rocky Vista Health Center LLC (Englewood, CO). Each 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 Michael Nickle'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 Michael Nickle was last updated on June 29, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years 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.