Individual provider Active NPI

Nikola Malic, M.D.

  • Family Medicine Physician
  • Wheeling, WV
National Provider Identifier
1033788104
Registry record updated Nov 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35.149850 Issued in OH
Practice address
Family Medicine Center
40 Medical Park Suite 401
Wheeling, WV 26003
Phone
(304) 243-3880
Fax
(304) 243-3895
NPI assigned
Jun 22, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 35.149850 OH Primary

Addresses

Primary practice location

Family Medicine Center
40 Medical Park Suite 401
Wheeling, WV 26003

Mailing address

Family Medicine Center
40 Medical Park Suite 401
Wheeling, WV 26003
Phone (304) 243-3880

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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 1

Enrollment IDStateProvider typePAC IDDetails
I20241126001585 OH Practitioner - Family Practice 3476088527 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

659 Boulevard St
Dover, OH 44622-2026
Phone (330) 343-3311

Hospital & facility affiliations

  • Union Hospital Hospital, Dover, OH, CCN 360010
  • Mercy Medical Center Hospital, Canton, OH, CCN 360070
  • Akron General Medical Center Hospital, Akron, OH, CCN 360027
  • Twin City Medical Center Hospital, Dennison, OH, CCN 361302

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35.149850OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hospitalist Medicine Physicians of Ohio, Professional Corporation Family Medicine CurrentSince Sep 6, 2024 Accepting new patients
The Union Hospital Association Past Accepting new patients

Locations

2420 Lake Ave
Ashtabula, OH 44004
Phone (216) 986-2919

659 Boulevard St
Dover, OH 44622
Phone (330) 343-3311

120 Brentwood Commons Way
Ste 510
Brentwood, TN 37027
Phone (253) 682-6040

Organizations & group practices 2

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1624320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730764800000",
    "number": "1033788104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FAMILY MEDICINE CENTER",
            "address_2": "40 MEDICAL PARK SUITE 401",
            "city": "WHEELING",
            "state": "WV",
            "postal_code": "26003",
            "telephone_number": "304-243-3880",
            "fax_number": "304-243-3895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "FAMILY MEDICINE CENTER",
            "address_2": "40 MEDICAL PARK SUITE 401",
            "city": "WHEELING",
            "state": "WV",
            "postal_code": "26003",
            "telephone_number": "304-243-3880",
            "fax_number": "304-243-3895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALIC",
        "first_name": "NIKOLA",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-22",
        "last_updated": "2024-11-05",
        "certification_date": "2024-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35.149850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheeling, WV

Sources for this page

Verify at the official NPI Registry.