Nicole Buckingham, APRN-CNP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

APRN.CNP.0028465 Issued in OH

Practice address

3535 Pentagon Blvd Ste 400
Beavercreek, OH 45431-1705

Phone

(855) 500-2873

Fax

(937) 490-2267

NPI assigned

Mar 2, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

University of Cincinnati College of Medicine, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kettering Independent Medical Group IncGroup PAC ID 3173710936, 699 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kettering Health Dayton Hospital, Dayton, OH, CCN 360133
• Kettering Health Miamisburg Hospital, Miamisburg, OH, CCN 360239
• Soin Medical Center Hospital, Beaver Creek, OH, CCN 360360

Merit-based Incentive Payment System (MIPS)

Final score

81.34 of 100Reported as group

Quality

63.67

Promoting interoperability

100

Improvement activities

40

Cost

74.14

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Kettering Independent Medical Group Inc

  • Orthopaedic Surgery Physician
  • Miamisburg, OH
  • NPI 1629387865
  Medicare reassignment Care Compare group NPD

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

• Beavercreek Medical Center

  • General Acute Care Hospital
  • Beavercreek, OH
  • NPI 1760764849
  Care Compare affiliation
• Dayton Osteopathic Hospital

  • General Acute Care Hospital
  • Dayton, OH
  • NPI 1053339507
  Care Compare affiliation
• Kettering Medical Center

  • General Acute Care Hospital
  • Miamisburg, OH
  • NPI 1316966518
  Care Compare affiliation

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

{
    "created_epoch": "1614643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702944000000",
    "number": "1053906156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PRESTIGE PL STE 550",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453426115",
            "telephone_number": "937-762-1310",
            "fax_number": "937-522-8068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 PENTAGON BLVD STE 400",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454311705",
            "telephone_number": "855-500-2873",
            "fax_number": "937-490-2267"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 W Main St Ste 103",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "OH",
            "postal_code": "453733384",
            "country_code": "US",
            "telephone_number": "855-500-2873",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUCKINGHAM",
        "first_name": "NICOLE",
        "credential": "APRN-CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-02",
        "last_updated": "2023-12-19",
        "certification_date": "2023-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SX0200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Oncology",
            "state": "OH",
            "license": "APRN.CNP.0028465",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "OH",
            "license": "APRN.CNP.0028465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nbuckingham5864@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "3535 Pentagon Blvd Ste 400",
            "city": "Beavercreek",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454311705",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "3535 Pentagon Blvd Ste 400",
            "city": "Beavercreek",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454311705",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Gina Marie Brummett, HIS
• Bryan Dodd DDS, Inc.
• Alex Michael Buchkovich
• Buckeye Behavior Services, LLC.
• Buckeye Behavioral Consulting Inc
• Christopher A Buckner, MPT
• Lan-Anh Bui, D.D.S.
• Kelly Bultman
• Hannah Bundy, OTR/L
• April Anne Bunn, M.D.

• Gerontology Nurse Practitioner in Beavercreek, OH
• Providers in Beavercreek, OH by specialty
• Gerontology Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 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.