Ms Nicole Denise Nickens, MSN, A-GPNP-BC, is a medicare enrolled "Nurse Practitioner" physician in Willoughby, Ohio. Her current practice location is
30841 Euclid Ave Ste 103, Willoughby, Ohio. You can reach out to her office (for appointments etc.) via phone at
(216) 441-2496.
Ms Nicole Denise Nickens is licensed to practice in Ohio (license number APRN.CNP.020745) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1609082486.
Physician's Profile
| Full Name | Ms Nicole Denise Nickens |
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| Gender | Female |
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| Speciality | Nurse Practitioner |
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| Location | 30841 Euclid Ave Ste 103, Willoughby, Ohio |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1609082486
- Provider Enumeration Date: 05/16/2007
- Last Update Date: 08/10/2024
Medicare PECOS Information:
- PECOS PAC ID: 0446537484
- Enrollment ID: I20170501001418
Medical Identifiers
Medical identifiers for Ms Nicole Denise Nickens such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1609082486 | NPI | - | NPPES |
| 0223866 | Medicaid | OH | |
| 2462777 | Medicaid | OH | |
| 1609082486 | Medicaid | OH | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207RA0401X | Internal Medicine - Addiction Medicine | CNP020745 (Ohio) | Secondary |
| 363L00000X | Nurse Practitioner | APRN.CNP.020745 (Ohio) | Primary |
| 163W00000X | Registered Nurse | RN346914 (Ohio) | Secondary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Ms Nicole Denise Nickens allows following entities to bill medicare on her behalf.
| Entity Name | Rakesh Ranjan Md & Associates, Inc. |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1033143722
PECOS PAC ID: 6507895067
Enrollment ID: O20050805000212 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Ms Nicole Denise Nickens is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Ms Nicole Denise Nickens, MSN, A-GPNP-BC,
30841 Euclid Ave Ste 103,
Willoughby, OH 44094-3100
Ph: (216) 441-2496 | Ms Nicole Denise Nickens, MSN, A-GPNP-BC,
30841 Euclid Ave Ste 103,
Willoughby, OH 44094-3100
Ph: (216) 441-2496 |
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