AMY NICHOLAS — NPI 1275490237 (Licensed & Credentialed Dental Hygienist in BOLIVAR, MO)

CMS-1500 Box 24J / 33a • NPI

1275490237

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

124Q00000X

Licensed & Credentialed Dental Hygienist

Box 32 Service Location & ZIP+4

203 E BROADWAY ST, BOLIVAR, MO, 65613-1623

✓ 9-Digit EDI 837 ZIP+4 (65613-1623)

Practice Phone & Referral Fax

(417) 328-6334

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1275490237 (AMY NICHOLAS) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1275490237` (NPI-1 Individual Practitioner)
Provider / Legal Name	AMY NICHOLAS
Plain-English Specialty	Licensed & Credentialed Dental Hygienist NUCC Code: `124Q00000X` (Dental Hygienist)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	203 E BROADWAY ST, BOLIVAR, MO, 65613-1623
Practice Telephone / Fax	Tel: (417) 328-6334
Administrative Mailing Address	PO BOX 125, HERMITAGE, MO, 65668-0125
Enumeration & Last Sync	Enumerated: 2026-01-09 \| CMS Record Updated: 2026-01-09

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

203 E BROADWAY ST, BOLIVAR, MO, 65613-1623

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Plain-English Taxonomy & CMS Crosswalk (124Q00000X)

What Does Taxonomy Code 124Q00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 124Q00000X translates to:
"Licensed & Credentialed Dental Hygienist"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Dental Hygienist for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (AMY NICHOLAS)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`124Q00000X` — Dental Hygienist Plain English: Licensed & Credentialed Dental Hygienist	State: MO \| License: `2003021669` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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AMY NICHOLAS (NPI #1275490237)