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DWAYNE NICKERSON
NPI 1780011437
Marriage & Family Therapist in Riverside, CA

Active since September 26, 2013PECOS EnrolledAccepts Medicare Assignment
4193 FLAT ROCK DR STE 200, RIVERSIDE, CA 92505(805) 242-4851(951) 329-5800 Get Directions Write a Review

NPPES record last updated: December 21, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Dec 27, 2018, Jul 29, 2018 (2 updates tracked since 2018).

About Dwayne Nickerson NPPES

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

DWAYNE NICKERSON (NPI 1780011437) is an individual marriage & family therapist in Riverside, California, licensed in California (LMFT96210) and active in the NPI registry since September 2013. He is enrolled in Medicare PECOS, maintains 3 additional practice locations, and is a graduate of Other (2013).

NPPES Registry Identity

NPI1780011437
Entity TypeIndividualMale
Primary Taxonomy106H00000X
Provider Legal NameDWAYNE NICKERSON
Location Address4193 FLAT ROCK DR STE 200Riverside, CA 92505-7113
Mailing Address4193 Flat Rock Dr Ste 200Riverside, CA 92505-7113 · (805) 242-4851
Phone(805) 242-4851
Fax(951) 329-5800
Sole ProprietorYes
Medical School CMSOtherGraduated 2013
Enumeration DateSeptember 26, 2013
Last NPPES UpdateDecember 21, 20232 updates tracked since enumeration
NPPES CertifiedDecember 21, 2023
✔ NPI 1780011437 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyMarriage & Family TherapistBehavioral Health & Social Service Providers
Taxonomy Code106H00000X
License✔ Licensed in CA · LMFT96210
Definition
A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups.
Also ListedRehabilitation PractitionerTaxonomy 225400000X
4193 FLAT ROCK DR STE 200, Riverside, CA 92505
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Secondary Practice Locations 3

Location 1301 S Miller St Ste 121Santa Maria, CA 93454 · Phone (310) 897-0140
Location 23787 S Vermont AveLos Angeles, CA 90007-4203 · Phone (323) 766-2345 ext. 2207
Location 3301 S Miller St Ste 112Santa Maria, CA 93454 · Phone (805) 361-0118 ext. 0118 · Fax (805) 332-3057

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

Dwayne Nickerson 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 ID9234573882
PECOS Enrollment IDI20240222000756
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 Dwayne Nickerson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Sud Specialty Group - Ca
349 mi
Addiction Medicine
4633 OLD IRONSIDES DR STE 304
Santa Clara, CA 95054
  • Reassigned Medicare billing, California enrollment
  • 1,607 clinicians in this Medicare group
NPI 1972138238 (323) 205-7088

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 16

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

FIRST EXPRESSIONS SPEECH-LANGUAGE PATHOLOGY SERVICES, INC.
Speech-Language Pathologist
4193 FLAT ROCK DR STE 200
RIVERSIDE, CA 92505
Riverside County (619) 807-4336
NESTOR JAVIER SANCHEZ M.S.
Marriage & Family Therapist
4193 FLAT ROCK DR STE 200
RIVERSIDE, CA 92505
Riverside County (951) 546-0012
LEE PREUSS
Marriage & Family Therapist
4193 FLAT ROCK DR STE 200
RIVERSIDE, CA 92505
Riverside County (951) 292-4693
JAQUELINE CERVANTES PACHECO
Behavior Analyst
4193 FLAT ROCK DR STE 200
RIVERSIDE, CA 92505
Riverside County (951) 440-6220
ANEESAH BARI AMFT
Marriage & Family Therapist
4193 FLAT ROCK DR STE 200
RIVERSIDE, CA 92505
Riverside County (951) 292-4693
AARIA FREIGHT
Non-emergency Medical Transport (VAN)
4193 FLAT ROCK DR STE 200
RIVERSIDE, CA 92505
Riverside County (310) 903-7810
BEYOND THERAPY HEALING CENTER LICENSED CLINICAL SOCIAL WORKER INC.
Clinic/Center (Mental Health (Including Community Mental Health Center))
4193 FLAT ROCK DR STE 200
RIVERSIDE, CA 92505
Riverside County (951) 292-4693
MICHELLE MORRISON LCSW
Social Worker (Clinical)
4193 FLAT ROCK DR STE 200
RIVERSIDE, CA 92505
Riverside County (951) 223-1205

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 Dwayne Nickerson's NPI number?

The NPI number for Dwayne Nickerson is 1780011437. It was assigned to this individual provider in the NPPES registry on September 26, 2013.

Where is Dwayne Nickerson located?

Dwayne Nickerson practices at 4193 Flat Rock Dr Ste 200, Riverside, CA 92505. The listed phone number is (805) 242-4851.

What is Dwayne Nickerson's specialty?

The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.

Is Dwayne Nickerson enrolled in Medicare?

Yes. Dwayne Nickerson 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 Dwayne Nickerson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Dwayne Nickerson reassigns Medicare benefits to Sud Specialty Group - Ca (Santa Clara, 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 Dwayne Nickerson'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 Dwayne Nickerson was last updated on December 21, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.