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

DR. NICHOLAS MATTHEW WISDOM PH.D.
NPI 1912260779
Clinical Neuropsychologist in League City, TX

Q: What is Nicholas Wisdom's NPI number?

The NPI number for Nicholas Wisdom is 1912260779. It was assigned to this individual provider in the NPPES registry on June 18, 2012.

Q: What is Nicholas Wisdom's specialty?

The primary specialty registered for this NPI is Clinical Neuropsychologist with taxonomy code 103G00000X.

Q: When was this NPI record last updated?

The NPPES record for Nicholas Wisdom was last updated on September 30, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 39 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.

Active since June 18, 2012PECOS Enrolled

112 MAGNOLIA ESTATES DR, LEAGUE CITY, TX 77573(888) 606-0086(346) 223-0296 Get Directions Write a Review

NPPES record last updated: September 30, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Sep 30, 2026, May 6, 2026, Apr 7, 2026 and 1 more (4 updates tracked since 2021).

On this page

About Dr. Nicholas Matthew Wisdom Ph.d. NPPES

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

DR. NICHOLAS MATTHEW WISDOM PH.D. (NPI 1912260779) is an individual clinical neuropsychologist in League City, Texas, licensed in Texas (37585) and active in the NPI registry since June 2012. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1912260779

Entity TypeIndividualMale

Primary Taxonomy103G00000X

Provider Legal NameDR. NICHOLAS MATTHEW WISDOMCredential: PH.D.

Location Address112 MAGNOLIA ESTATES DRLeague City, TX 77573-4719

Mailing Address112 Magnolia Estates DrLeague City, TX 77573-4719 · (888) 606-0086 · Fax (346) 223-0296

Phone(888) 606-0086

Fax(346) 223-0296

Sole ProprietorNo

Enumeration DateJune 18, 2012

Last NPPES UpdateSeptember 30, 20264 updates tracked since enumeration

NPPES CertifiedSeptember 30, 2026

✔ NPI 1912260779 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinical NeuropsychologistBehavioral Health & Social Service Providers

Taxonomy Code103G00000X

Licenses✔ Licensed in TX · 37585✔ Licensed in FL · PY10489✔ Licensed in LA · 1549

Definition

A clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing the understanding of brain-behavior relationships and the application of such knowledge to human problems.

Also ListedPsychologist · ClinicalTaxonomy 103TC0700X · License 37585 (TX), PY10489 (FL), 1549 (LA)

112 MAGNOLIA ESTATES DR, League City, TX 77573

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Louisiana, Cigna Healthcare, Cigna HealthCare of Florida, Inc. and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Nicholas Matthew Wisdom Ph.d. 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.

Medicare Billing Reassignment

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

Neurocognitive Specialty Group, PLLC

Same address

Clinical Neuropsychologist

112 MAGNOLIA ESTATES DR
League City, TX 77573

Reassigned Medicare billing, Florida, Louisiana and Texas enrollments
4 clinicians in this Medicare group

NPI 1346700275 (888) 606-0086

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 3

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

LAURA MAI PH.D.

Psychologist

112 MAGNOLIA ESTATES DR
LEAGUE CITY, TX 77573

Galveston County (888) 606-0086

NEUROCOGNITIVE SPECIALTY GROUP, PLLC

Clinical Neuropsychologist

112 MAGNOLIA ESTATES DR
LEAGUE CITY, TX 77573

Galveston County (888) 606-0086

JONATHAN PARKS FILLAUER PHD, ABPP-CN

Clinical Neuropsychologist

112 MAGNOLIA ESTATES DR
LEAGUE CITY, TX 77573

Galveston County (888) 606-0086

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 Nicholas Wisdom's NPI number?

The NPI number for Nicholas Wisdom is 1912260779. It was assigned to this individual provider in the NPPES registry on June 18, 2012.

Where is Nicholas Wisdom located?

Nicholas Wisdom practices at 112 Magnolia Estates Dr, League City, TX 77573. The listed phone number is (888) 606-0086.

What is Nicholas Wisdom's specialty?

The primary specialty registered for this NPI is Clinical Neuropsychologist with taxonomy code 103G00000X.

Is Nicholas Wisdom enrolled in Medicare?

Yes. Nicholas Wisdom is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Nicholas Wisdom's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Nicholas Wisdom reassigns Medicare benefits to Neurocognitive Specialty Group, PLLC (League City, TX). 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 Nicholas Wisdom's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Nicholas Wisdom accept?

Health plans from Blue Cross and Blue Shield of Louisiana, Cigna HealthCare of Florida, Inc., Cigna Healthcare, HMO Louisiana and Molina Healthcare list Nicholas Wisdom as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Nicholas Wisdom was last updated on September 30, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 39 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.