Charles R Nicolosi, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

20585 Issued in MN

Practice address

116 Mill St W.
Cannon Falls, MN 55009-2027

Phone

(608) 788-8103

NPI assigned

Oct 25, 2006

Last updated

Nov 14, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Charles R Nicolosi Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

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

• Charles R Nicolosi M.D.

  • Specialist
  • La Crosse, WI
  • NPI 1366627895
  Authorized official Same address or phone

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194998400000",
    "number": "1063596831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2031 32ND ST S",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546017099",
            "telephone_number": "608-788-8103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 MILL ST W.",
            "city": "CANNON FALLS",
            "state": "MN",
            "postal_code": "550092027",
            "telephone_number": "608-788-8103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICOLOSI",
        "first_name": "CHARLES",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2007-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MN",
            "license": "20585",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MN",
            "identifier": "127T7NI",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHARLES",
            "last_name": "NICOLOSI",
            "middle_name": "R",
            "prefix": "DR.",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Amy Lee McAlister, APRN, CNP, DNP
• McIntee Chiropractic Clinic
• Patrick James McIntee, DC
• Kala Marie Moline
• Nash-Finch LLC (Family Fare Pharmacy 3348)
• Thomas W Nordahl, MD
• Gail Mae Olson, M.D.
• Sheryl Lynn Otto, ADULT FOSTER CARE
• Dillon Noah Patrick, DPT
• Emily Paulson, PHARMD

• Specialist in Cannon Falls, MN
• Providers in Cannon Falls, MN by specialty
• Specialist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.