Individual provider Active NPI

Nicole Dennis, MD

  • Diagnostic Radiology Physician
  • Utica, NY
National Provider Identifier
1083175475
Registry record updated Aug 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
338426 Issued in NY
Practice address
111 Hospital Dr
Utica, NY 13502-2517
Phone
(315) 917-9966
Fax
(315) 234-3998
NPI assigned
Mar 27, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X A176854 CA
Student in an Organized Health Care Education/Training Program 390200000X TL.0007572 CO
Student in an Organized Health Care Education/Training Program 390200000X 0116038848 VA
Diagnostic Radiology Physician 2085R0202X 338426 NY Primary

Addresses

Primary practice location

111 Hospital Dr
Utica, NY 13502-2517

Mailing address

111 Hospital Dr
Utica, NY 13502-2517
Phone (315) 801-8534

Other practice location 1

1200 N State St
Los Angeles, CA 90089-1001
Phone (323) 409-7242

Other practice location 2

1215 Lee St.
Box 800377
Charlottesville, VA 22908-0816
Phone (434) 924-9400

Other practice location 3

1960 N Ogden St Ste 400
Denver, CO 80218-3670
Phone (303) 318-1540

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20250822001188 NY Practitioner - Diagnostic Radiology 7315277019 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Loma Linda University School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MVHS IncGroup PAC ID 2769380252, 330 clinicians
Radiology Associates of New Hartford LLPGroup PAC ID 6002807831, 21 clinicians

Practice addresses (Care Compare)

111 Hospital Dr
Utica, NY 13502-2517
Phone (315) 624-6000

1500 N James St
Rome, NY 13440-2844
Phone (315) 338-7027

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
338426NYMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
MVHS Inc CurrentSince Sep 1, 2025 Accepting new patients
MVHS Inc CurrentSince Sep 1, 2025 Accepting new patients
Radiology Associates of New Hartford LLP Diagnostic Radiology CurrentSince Aug 6, 2025 Accepting new patients
Cmi Professional Services CurrentSince Aug 6, 2025 Accepting new patients

Locations

1656 Champlin Ave
New Hartford, NY 13413
Phone (315) 624-6222

1500 N James St
Rome, NY 13440
Phone (315) 338-7000

1903 Sunset Ave
Ste 3
Utica, NY 13502
Phone (315) 797-1212

107 Business Park Dr
Utica, NY 13502
Phone (315) 792-4666

1676 Sunset Ave
Utica, NY 13502
Phone (315) 624-5567

111 Hospital Dr
Utica, NY 13502
Phone (315) 801-8534

Organizations & group practices 4

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 9

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": "1553644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755129600000",
    "number": "1083175475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 HOSPITAL DR",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135022517",
            "telephone_number": "315-801-8534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 HOSPITAL DR",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135022517",
            "telephone_number": "315-917-9966",
            "fax_number": "315-234-3998"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 N State St",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900891001",
            "country_code": "US",
            "telephone_number": "323-409-7242",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1215 Lee St.",
            "address_2": "Box 800377",
            "address_purpose": "LOCATION",
            "city": "Charlottesville",
            "state": "VA",
            "postal_code": "229080816",
            "country_code": "US",
            "telephone_number": "434-924-9400",
            "fax_number": "434-243-6731",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1960 N Ogden St Ste 400",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802183670",
            "country_code": "US",
            "telephone_number": "303-318-1540",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DENNIS",
        "first_name": "NICOLE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-27",
        "last_updated": "2025-08-14",
        "certification_date": "2025-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A176854",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CO",
            "license": "TL.0007572",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "VA",
            "license": "0116038848",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "338426",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Utica, NY

Sources for this page

Verify at the official NPI Registry.