Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1073299236 Individual Practitioner Female Practitioner

Nicole Bertram , PA

Physician Assistant • Jbsa Lackland, TX

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Nicole Bertram, PA is a certified Physician Assistant practicing in Jbsa Lackland, TX. With approximately 3 years of clinical experience since graduating from San Juan Bautista School Of Medicine in 2023, Nicole Bertram delivers high-quality medical care to the local community at 1100 WILFORD HALL LOOP.

Nicole Bertram is affiliated with M Reza Mizani Md Pa and accepts Medicare assignment.

Practice Location & Contact Primary Location

Practice Address

1100 Wilford Hall Loop

Jbsa Lackland, TX 782365638

Telephone 2102925000

Medicare Profile & Education

Medical School

San Juan Bautista School Of Medicine

Graduation Year

2023

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Jbsa Lackland, TX

Rising Specialist (<5 Yrs)
Practitioner Clinical Experience
3 Yrs -9.8 yrs vs City Avg
City Avg: 12.8 Yrs
State Avg: 13.9 Yrs
Regional Practice Density
37 Specialists

Practicing in Jbsa Lackland, TX (11140 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Bertram (3 Years) 3 Yrs
Jbsa Lackland Specialty Average (12.8 Years) 12.8 Yrs

Medical Specialties & State Licenses

CMS Verified: 2026-04-10
Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

State License TX PA17014

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Physician Assistant - Medical

NUCC Taxonomy Code: 363AM0700X

Definition to come...

Hospital & Practice Group Affiliations

M Reza Mizani Md Pa

205 22nd St, Hondo, TX 788612520

Phone: 2106147900

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
Dr. Henry Foerster , DMD

Dentist - Periodontics

NPI 1003150673

Doctor of Dental Medicine

NPI 1003317744

Doctor of Osteopathic Medicine (D.O.)

Dr. Paramjit Bhullar , MD

Ophthalmology - Cornea and External Diseases Specialist

NPI 1003348046

Doctor of Medicine (M.D.)

NPI 1003377599

Doctor of Medicine (M.D.)

Dr. Daniel Weidner , DO

Emergency Medicine

NPI 1003441106

Doctor of Osteopathic Medicine (D.O.)

Michell Llerena

Psychiatry & Neurology - Psychiatry

NPI 1003601808

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

13 Historical Events
📍
Updated Practice Location April 10, 2026

Registered at 1100 WILFORD HALL LOOP, JBSA LACKLAND, TX 782365638 (Tel: 2102925000)

📍
Updated Business Mailing Address April 10, 2026

Registered at 1100 WILFORD HALL LOOP, JBSA LACKLAND, TX 782365638 (Tel: 2102925000)

📍
Updated Practice Location May 20, 2025

Registered at 215 N SAN SABA STE 201A, SAN ANTONIO, TX 782073120 (Tel: 2105473430)

📍
Updated Business Mailing Address May 20, 2025

Registered at PO BOX 650002 DEPT 8286, DALLAS, TX 752650029 (Tel: 2106156626)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) May 20, 2025

Physician Assistant (License #PA17014 in TX)

📍
Updated Practice Location February 25, 2025

Registered at 1100 WILFORD HALL LOOP, JBSA LACKLAND, TX 782365638 (Tel: 2105232273)

📍
Updated Business Mailing Address February 25, 2025

Registered at 1100 WILFORD HALL LOOP, JBSA LACKLAND, TX 782365638

NPI Profile Active June 28, 2023

NPI status registered as active in NPPES database

📍
Updated Practice Location June 28, 2023

Registered at 318 W LOOP 1604 N, SAN ANTONIO, TX 782453194 (Tel: 2105232273)

📍
Updated Business Mailing Address June 28, 2023

Registered at 318 W LOOP 1604 N, SAN ANTONIO, TX 782453194 (Tel: 2103300614)

👤
Provider Name / Credentials Updated June 28, 2023

Recorded as NICOLE BERTRAM, PA

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) June 28, 2023

Physician Assistant

🟢
Initial NPI Registration & Enumeration June 23, 2023

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1073299236
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: June 23, 2023
Last Update: April 10, 2026
Sole Proprietor: No

Mailing Address

1100 Wilford Hall Loop

Jbsa Lackland, TX 782365638

Phone: 2102925000

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.