Individual provider Active NPI

Daniel Nathan Nichols, PA-C

  • Physician Assistant
  • Cleveland, OH
National Provider Identifier
1043595911
Registry record updated Feb 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
015383-1 Issued in NY
Practice address
2500 Metrohealth Dr
Cleveland, OH 44109-1900
Phone
(216) 778-7800
NPI assigned
Oct 11, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 015383-1 NY Primary
Physician Assistant 363A00000X PA9119112 FL
Physician Assistant 363A00000X 2271845 ID
Surgical Physician Assistant 363AS0400X 015383-1 NY

Addresses

Primary practice location

2500 Metrohealth Dr
Cleveland, OH 44109-1900

Mailing address

2500 Metrohealth Dr
Cleveland, OH 44109-1900
Phone (216) 778-7800

Other practice location 1

800 Meadows Rd
Boca Raton, FL 33486-2304
Phone (561) 955-7100

Other practice location 2

190 E Bannock St Fl 10
Boise, ID 83712-6241
Phone (208) 381-5500

Other identifiers 4

IdentifierTypeStateIssuer
1043595911OtherNYUNIVERA
120326000119OtherNYFIDELIS
9516980OtherNYINDEPENDENT HEALTH ASSOCIATION
000534102001OtherNYBCBS OF WNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dnichols113487@direct.metrohealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, ID2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160127002291 OH Practitioner - Physician Assistant 8921268533 Reassigns benefits to 1 organization
I20250214002710 ID Practitioner - Physician Assistant 8921268533 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Clinic-Treasure Valley LLCGroup PAC ID 4981878402, 1,155 clinicians
The Metrohealth SystemGroup PAC ID 8628982949, 1,150 clinicians

Practice addresses (Care Compare)

100 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-2983

190 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-9384

2500 Metrohealth Dr
Cleveland, OH 44109-1900
Phone (216) 778-7800

2500 Metrohealth Dr
Cleveland, OH 44109-1998

608 W Hays St
Boise, ID 83702-5511
Phone (208) 381-5970

610 W Hays St
Boise, ID 83702-5511
Phone (208) 381-5970

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
015383-1NYMDSpeech-Language Pathologist
PA9119112FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC CurrentSince Feb 6, 2025 Accepting new patients
The Metrohealth System Current Accepting new patients
The Metrohealth System CurrentSince Jan 18, 2016 Accepting new patients
The Metrohealth System Past Accepting new patients
St Lukes Regional Medical Center Past Accepting new patients

Locations

190 E Bannock St
#10
Boise, ID 83712

222 N 2nd St
Ste 215
Boise, ID 83702
Phone (208) 342-2706

190 E Bannock St
Fl 10
Boise, ID 83712
Phone (208) 381-5500

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

520 S Eagle Rd
Ste 1201
Meridian, ID 83642
Phone (208) 706-5988

2500 Metrohealth Dr
Cleveland, OH 44109
Phone (216) 778-2348

4229 Pearl Rd
Cleveland, OH 44109
Phone (216) 459-6300

Organizations & group practices 5

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 2

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": "1318291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738800000000",
    "number": "1043595911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 METROHEALTH DR",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441091900",
            "telephone_number": "216-778-7800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 METROHEALTH DR",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441091900",
            "telephone_number": "216-778-7800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Meadows Rd",
            "address_purpose": "LOCATION",
            "city": "Boca Raton",
            "state": "FL",
            "postal_code": "334862304",
            "country_code": "US",
            "telephone_number": "561-955-7100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "190 E Bannock St Fl 10",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837126241",
            "country_code": "US",
            "telephone_number": "208-381-5500",
            "fax_number": "208-381-2555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "DANIEL",
        "middle_name": "NATHAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-11",
        "last_updated": "2025-02-06",
        "certification_date": "2025-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "015383-1",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9119112",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "2271845",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "015383-1",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "1043595911",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIDELIS",
            "identifier": "120326000119",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENT HEALTH ASSOCIATION",
            "identifier": "9516980",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF WNY",
            "identifier": "000534102001",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dnichols113487@direct.metrohealth.org",
            "affiliation": "N",
            "address_1": "2500 Metrohealth Dr",
            "city": "Cleveland",
            "state": "OH",
            "country_code": "US",
            "postal_code": "441091900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.