Benjamin P Nicholson, M.D., M.A.

Primary specialty

Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X

License

4301106941 Issued in MI

Practice address

2848 Niles Rd
Saint Joseph, MI 49085-3352

Phone

(269) 428-3300

Fax

(269) 428-5005

NPI assigned

Jul 19, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI, IN2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Ophthalmology

Education

Saint Louis University School of Medicine, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Great Lakes Eye Care PCGroup PAC ID 8426091992, 12 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lakeland Hospital, St Joseph Hospital, St Joseph, MI, CCN 230021

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts, Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: bnicholson@greateyecare.direct.eyemdemr.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Great Lakes Eye Care PC

  • Ophthalmology Physician
  • Saint Joseph, MI
  • NPI 1922002708

  IN

  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Lakeland Hospitals at Niles and St Joseph, Inc

  • General Acute Care Hospital
  • Saint Joseph, MI
  • NPI 1134220031
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682467200000",
    "number": "1003016916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2848 NILES RD",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490853352",
            "telephone_number": "269-428-3300",
            "fax_number": "269-428-5005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2848 NILES RD",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490853352",
            "telephone_number": "269-428-3300",
            "fax_number": "269-428-5005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "BENJAMIN",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "M.D., M.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-19",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MI",
            "license": "4301106941",
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "MI",
            "license": "4301106941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• New Hope Counseling Agency, PLLC
• Tyler Newman
• Hanh Nguyen, M.D.
• Tho T K Nguyen, DO
• William H Nichols Jr., DO
• Angela M Nickens, FNP
• Amanda Noakes
• Scott Nolte, PT
• Liliane Nyamuziga, NP
• Reginah Nyamwaya

• Retina Specialist (Ophthalmology) Physician in Saint Joseph, MI
• Providers in Saint Joseph, MI by specialty
• Retina Specialist (Ophthalmology) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.