NPIMap

Individual provider Active NPI

Nicole D Hancock, DPM

  • Foot & Ankle Surgery Podiatrist
  • Leesburg, FL
National Provider Identifier
1043217425
Registry record updated Jul 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
PO3581 Issued in FL
Practice address
1330 Citizens Blvd
Suite 301
Leesburg, FL 34748-3959
Phone
(352) 728-1252
Fax
(352) 728-0079
NPI assigned
Jun 30, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X PO3581 FL Primary

Addresses

Primary practice location

1330 Citizens Blvd
Suite 301
Leesburg, FL 34748-3959

Mailing address

1330 Citizens Blvd
Suite 301
Leesburg, FL 34748-3959
Phone (352) 728-1252

Other identifiers 1

IdentifierTypeStateIssuer
8AD031OtherBLUE CROSS/BLUE SHIELD

Other names 1

  • Nicole D Klueh Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130125000028 FL Practitioner - Podiatry 2365341831 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Barry University School of Podiatric Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lake Foot and Ankle PAGroup PAC ID 8224120662, 3 clinicians
Cora Health Services IncGroup PAC ID 1759290992, shared by 21 NPIs, 1,125 clinicians

Practice addresses (Care Compare)

1330 Citizens Blvd
Suite 301
Leesburg, FL 34748-3941
Phone (352) 728-1252

2953 Traverse TRL
The Villages, FL 32163-2017
Phone (352) 693-3378

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
62.92 of 100Reported as group
Quality
79.56
Promoting interoperability
0
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue118
Removal of skin lesions29
Removal of nail tissue804
Removal or shaving of skin growth137
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1669TXMDDental Hygienist
PO3581FLMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Foot and Ankle PA Foot & Ankle Surgery CurrentSince Dec 19, 2012 Accepting new patients
Lepow Podiatric Medical Associates Past Accepting new patients
Foot and Ankle Associates of North Texas, LLP Foot & Ankle Surgery Past Accepting new patients
Foot and Ankle Associates of North Texas, LLP Foot & Ankle Surgery PastSince Jan 1, 2003 Accepting new patients
Lepow Podiatric Medical Associates Foot & Ankle Surgery Past Accepting new patients
Home Foot Care, LLP Past Accepting new patients

Locations

1330 Citizens Blvd
Ste 301
Leesburg, FL 34748
Phone (352) 728-1252

910 Old Camp Rd
Ste 112
The Villages, FL 32162
Phone (352) 240-1471

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 6

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": "1120089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562544000000",
    "number": "1043217425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1330 CITIZENS BLVD",
            "address_2": "SUITE 301",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347483959",
            "telephone_number": "352-728-1252",
            "fax_number": "352-728-0079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 CITIZENS BLVD",
            "address_2": "SUITE 301",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347483959",
            "telephone_number": "352-728-1252",
            "fax_number": "352-728-0079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANCOCK",
        "first_name": "NICOLE",
        "middle_name": "D",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-30",
        "last_updated": "2019-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "FL",
            "license": "PO3581",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "8AD031",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "KLUEH",
            "middle_name": "D",
            "credential": "DPM",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Leesburg, FL

Sources for this page

Verify at the official NPI Registry.