NICOLE ALISSA DEATHERAGE
NPI 1417691338
Pathology - Anatomic Pathology & Clinical Pathology in Tucson, AZ
NPI Status: Active since April 26, 2022
Contact Information
1625 N CAMPBELL AVE
TUCSON, AZ
ZIP 85719
Phone: (520) 626-6830
- Individual
- Female
- Pathology
- Anatomic Pathology & Clinical Pathology
- PECOS Enrolled
About NICOLE DEATHERAGE
This page provides the complete NPI Profile along with additional information for Nicole Deatherage, a provider established in Tucson, Arizona with a medical specialization in Pathology, focusing in anatomic pathology & clinical pathology . The healthcare provider is registered in the NPI registry with number 1417691338 assigned on April 2022. The practitioner's primary taxonomy code is 207ZP0102X with license number R79300 (AZ). The provider is registered as an individual and her NPI record was last updated 3 years ago.
- NPI
- 1417691338
- Provider Name
- NICOLE ALISSA DEATHERAGE
- Gender
- Female
- Entity Type
- Individual
- Location Address
- 1625 N CAMPBELL AVE TUCSON, AZ 85719
- Location Phone
- (520) 626-6830
- Mailing Address
- 1501 N CAMPBELL AVE TUCSON, AZ 85724
- Mailing Phone
- (520) 626-6830
- Mailing Fax
- Is Sole Proprietor?
- Yes
- Enumeration Date
- 04-26-2022
- Last Update Date
- 04-26-2022
- 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
Pathology Anatomic Pathology & Clinical Pathology
- Taxonomy Code
- 207ZP0102X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- R79300
- License State
- AZ
- Taxonomy Description
- A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease.
Medicare Participation & PECOS Enrollment Status
Nicole Deatherage 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, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
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): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
Physician Visit Costs
The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.
For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.
The prices below reflect the costs for new and established patients in the 85719 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99204
- Average New Patient Price $127.71
- Minimum New Patient Price $55.44
- Maximum New Patient Price $168.6
- Average New Patient Copayment $31.92
- Minimum New Patient Copayment $13.86
- Maximum New Patient Copayment $42.15
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99214
- Average Established Patient Price $98
- Minimum Established Patient Price $17.72
- Maximum Established Patient Price $137.41
- Average Established Patient Copayment $24.5
- Minimum Established Patient Copayment $4.43
- Maximum Established Patient Copayment $34.35
* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 4 | 1 | 7 | 6 | 9 | 1 | 3 | 3 | 8 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 4 | 2 | 7 | 12 | 9 | 2 | 3 | 6 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 4 + 2 + 7 + 1 + 2 + 9 + 2 + 3 + 6 + 24 = 62 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 70 - 62 = 8 | 8 | ||||||||
The NPI number 1417691338 is valid because the calculated check digit 8 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 20 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1073836722 | NANCY CHEN MD Individual | Hospitalist | 1625 N CAMPBELL AVE TUCSON, AZ 85719 (520) 626-6614 |
| 1578025193 | JAMES H SMITT MD Individual | Emergency Medicine | 1625 N CAMPBELL AVE TUCSON, AZ 85719 (520) 626-7233 |
| 1437506904 | DR. CHRISTOPHER BRIAN JOHNSON M.D. Individual | Internal Medicine | 1625 N CAMPBELL AVE TUCSON, AZ 85719 (520) 694-0111 |
| 1104488253 | LAURA SANDT FNP-C Individual | Nurse Practitioner (Family) | 1625 N CAMPBELL AVE TUCSON, AZ 85719 (520) 694-6000 |
| 1255890737 | HEATHER FYDRYCH Individual | Nurse Practitioner (Pediatrics) | 1625 N CAMPBELL AVE TUCSON, AZ 85719 (520) 694-0000 |
| 1730739152 | GRACE HYEYOUNG PARK Individual | Pharmacist | 1625 N CAMPBELL AVE TUCSON, AZ 85719 (520) 694-0111 |
| 1255779385 | MICHELINA CALIN DE LA MAZA MD Individual | Pediatrics | 1625 N CAMPBELL AVE TUCSON, AZ 85719 (520) 626-7053 |
| 1982040036 | GALEN GARCIA M.D. Individual | Anesthesiology (Pediatric Anesthesiology) | 1625 N CAMPBELL AVE TUCSON, AZ 85719 (520) 694-0111 |
| 1396381190 | SHEILA MICKELS Individual | Nurse Anesthetist, Certified Registered | 1625 N CAMPBELL AVE TUCSON, AZ 85719 (520) 694-0111 |
| 1477924082 | MRS. STEPHANIE WALLACE PA-C Individual | Physician Assistant | 1625 N CAMPBELL AVE TUCSON, AZ 85719 (520) 694-0111 |
| 1467099143 | MRS. ADRIANA JAZMIN MEDEIROS FNP Individual | Nurse Practitioner (Family) | 1625 N CAMPBELL AVE TUCSON, AZ 85719 (520) 694-0111 |
| 1447879267 | BARBARA ALVA MAYER NP Individual | Nurse Practitioner (Acute Care) | 1625 N CAMPBELL AVE TUCSON, AZ 85719 (520) 694-0111 |
| 1891324992 | KATIE SANDUSKY MSN/FNP-BC Individual | Nurse Practitioner (Family) | 1625 N CAMPBELL AVE TUCSON, AZ 85719 (520) 694-0111 |
| 1730708397 | SPENCER JEFFREY KNIGHT MD Individual | Student in an Organized Health Care Education/Training Program | 1625 N CAMPBELL AVE TUCSON, AZ 85719 (520) 694-0111 |
| 1669092599 | MADELINE MERCIER Individual | Emergency Medicine | 1625 N CAMPBELL AVE TUCSON, AZ 85719 (520) 626-7233 |
| 1134749872 | ALFONSO TADEUS ZAVALA Individual | Student in an Organized Health Care Education/Training Program | 1625 N CAMPBELL AVE TUCSON, AZ 85719 (520) 694-0111 |
| 1457971996 | DR. JONATHAN ALLEN SEAMAN MD Individual | Urology | 1625 N CAMPBELL AVE TUCSON, AZ 85719 (520) 694-0111 |
| 1992325435 | DR. JONATHAN PATRICK COSS MD Individual | Emergency Medicine | 1625 N CAMPBELL AVE TUCSON, AZ 85719 (520) 626-7233 |
| 1750902110 | SAMUEL MEADE FREEDMAN Individual | Emergency Medicine | 1625 N CAMPBELL AVE TUCSON, AZ 85719 (520) 626-7233 |
| 1649891011 | DARIEN STRATTON MD Individual | Emergency Medicine | 1625 N CAMPBELL AVE TUCSON, AZ 85719 (520) 694-0111 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1417691338, enumerated in the NPI registry as an "individual" on April 26, 2022
The provider is located at 1625 N Campbell Ave Tucson, Az 85719 and the phone number is (520) 626-6830
The provider's speciality is Pathology with taxonomy code 207ZP0102X with a focus in Anatomic Pathology & Clinical Pathology
Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
Medicare beneficiaries should expect a typical cost of $127.71 with an average copayment of $31.92 for new patient appointments. Established patients should expect a typical charge of $98 and an average copayment of 24.5. Please review your insurance plan or contact the provider directly to determine your specific costs.
This NPI record was last updated on April 26, 2022. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.