DR. NICHOLAS MATTHEW WISDOM PH.D.
NPI 1912260779
Clinical Neuropsychologist in League City, TX
NPI Status: Active since June 18, 2012
Contact Information
112 MAGNOLIA ESTATES DR
LEAGUE CITY, TX
ZIP 77573
Phone: (888) 606-0086
Fax: (346) 223-0296
- Individual
- Male
- Clinical Neuropsychologist
- Accepts Insurance
- PECOS Enrolled
About NICHOLAS WISDOM
This page provides the complete NPI Profile along with additional information for Nicholas Wisdom, a provider established in League City, Texas with a medical specialization in Clinical Neuropsychologist. The healthcare provider is registered in the NPI registry with number 1912260779 assigned on June 2012. The practitioner's primary taxonomy code is 103G00000X with license number 37585 (TX). The provider is registered as an individual and his NPI record was last updated May 2026.
- NPI
- 1912260779
- Provider Name
- DR. NICHOLAS MATTHEW WISDOM PH.D.
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 112 MAGNOLIA ESTATES DR LEAGUE CITY, TX 77573
- Location Phone
- (888) 606-0086
- Location Fax
- (346) 223-0296
- Mailing Address
- 112 MAGNOLIA ESTATES DR LEAGUE CITY, TX 77573
- Mailing Phone
- (888) 606-0086
- Mailing Fax
- (346) 223-0296
- Is Sole Proprietor?
- No
- Enumeration Date
- 06-18-2012
- Last Update Date
- 05-06-2026
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinical Neuropsychologist
- Taxonomy Code
- 103G00000X
- Type
- Behavioral Health & Social Service Providers
- License No.
- 37585
- License State
- TX
- Taxonomy Description
- 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.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | PY10489 (FL) |
| 2 | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 1549 (LA) |
| 3 | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | 37585 (TX) |
| 4 | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | PY10489 (FL) |
| 5 | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | 1549 (LA) |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Blue Max 70/50 $6700 with 2 $0 PCP Virtual Visits HSA Eligible - PPO
- Blue Max 80/60 $1500 with 2 $0 PCP Virtual Visits - PPO
- Blue Max Copay (PCP) 50/50 $3300 with 2 $0 PCP Virtual Visits - PPO
- Blue Max Copay (PCP) 50/50 $7500 Standardized HSA Eligible - PPO
- Blue Max Copay (PCP) 60/40 $6000 Standardized - PPO
- Blue Max Copay (PCP) 75/55 $2000 Standardized - PPO
- Blue Saver 60/40 $6100 - PPO
- Blue Saver 90/70 $3400 - PPO
- Blue POS 60/40 $6500 with 2 $0 PCP Virtual Visits HSA Eligible - POS
- Blue POS 80/60 $3200 with 2 $0 PCP Virtual Visits - POS
- Blue POS 90/70 $9900 with 2 $0 PCP Virtual Visits HSA Eligible - POS
- Blue POS Copay (PCP) 50/50 $7500 Standardized HSA Eligible - POS
- Blue POS Copay (PCP) 60/40 $6000 Standardized - POS
- Blue POS Copay (PCP) 75/55 $2000 Standardized - POS
- Blue POS Copay (PCP) 80/60 $1000 with 2 $0 PCP Virtual Visits - POS
- Signature Blue 80/60 $3200 with 2 $0 PCP Virtual Visits - POS
- Signature Blue 90/70 $9900 with 2 $0 PCP Virtual Visits HSA Eligible - POS
- Signature Blue Copay (PCP) 50/50 $7500 Standardized HSA Eligible - POS
- Signature Blue Copay (PCP) 60/40 $6000 Standardized - POS
- Signature Blue Copay (PCP) 75/55 $2000 Standardized - POS
- Molina Gold Core 1640 - HMO
- Molina Gold Core 1640 Plus with Adult Dental and Vision - HMO
- Molina Gold Core 1640 Plus with Adult Vision - HMO
- Molina Gold Saver 750 - HMO
- Molina Gold Saver 750 Plus with Adult Dental and Vision - HMO
- Molina Gold Saver 750 Plus with Adult Vision - HMO
- Molina Gold Standard - HMO
- Molina Silver Core - HMO
- Molina Silver Core Plus with Adult Dental and Vision - HMO
- Molina Silver Core Plus with Adult Vision - HMO
- Molina Silver Saver with Four Free PCP Visits - HMO
- Molina Silver Standard - HMO
- Bronze Classic 4700 - EPO
- Bronze Classic Standard - EPO
- Bronze Elite + PCP Saver Plus - EPO
- Bronze Simple Breathe Easy with Enhanced COPD Benefits - EPO
- Bronze Simple Chronic Care CKM - EPO
- Bronze Simple Diabetes - EPO
- Gold Classic - EPO
- Gold Classic Standard - EPO
- Gold Elite - EPO
- Silver Classic - EPO
- Silver Classic Standard - EPO
- Silver Simple PCP Saver - EPO
- UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care) - HMO
- UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) - EPO
- UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) - HMO
- UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, Dental + Vision) - HMO
- UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, Dental + Vision, No Referrals) - EPO
- UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, Dental + Vision, No Referrals) - HMO
- UHC Bronze Essential ($0 Virtual Urgent Care) - HMO
- UHC Bronze Essential- ($0 Virtual Urgent Care) - HMO
- UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals) - EPO
- UHC Bronze Essential (No Referrals) - EPO
- UHC Bronze Essential (No Referrals) - HMO
- UHC Bronze Standard - HMO
- UHC Bronze Standard (No Referrals) - EPO
- UHC Bronze Standard (No Referrals) - HMO
- UHC Bronze Standard+ (Dental + Vision) - HMO
- UHC Bronze Standard+ (Dental + Vision, No Referrals) - EPO
- UHC Bronze Standard+ (Dental + Vision, No Referrals) - HMO
- UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx) - HMO
- UHC Gold Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) - EPO
- UHC Gold Advantage ($0 Virtual Urgent Care, $5 Tier 2 Rx, No Referrals) - EPO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Medicare Participation & PECOS Enrollment Status
Nicholas Wisdom is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging and Durable Medical Equipment (DME).
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): No
Eligible to Order or Refer Power Mobility Devices: No
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1912260779, we treat the final digit (9) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 61. The final step is to find the difference between that total and the next multiple of ten (70 - 61 = 9).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 61 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 2 providers are registered at the same or a nearby location.
LEAGUE CITY, TX 77573
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1912260779, enumerated as an "individual" on June 18, 2012.
The provider is located at 112 MAGNOLIA ESTATES DR LEAGUE CITY, TX 77573 and the phone number is (888) 606-0086.
Clinical Neuropsychologist with taxonomy code 103G00000X.
The provider might be accepting Accepts: Blue Cross and Blue Shield of Louisiana, HMO. Please consult your insurance carrier or call the provider to verify.
