Individual provider Active NPI

Nicole Renee Lasich

  • Physician Assistant
  • Sylvania, OH
National Provider Identifier
1124853619
Registry record updated Jun 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.009453RX Issued in OH
Practice address
5308 Harroun Rd Ste 280
Sylvania, OH 43560-2190
Phone
(567) 585-2080
NPI assigned
Sep 4, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50.009453RX OH Primary

Addresses

Primary practice location

5308 Harroun Rd Ste 280
Sylvania, OH 43560-2190

Mailing address

5300 Harroun Rd Ste 280
Sylvania, OH 43560-2146

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250917001028 OH Practitioner - Physician Assistant 3779087432 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Promedica Central PhysiciansGroup PAC ID 2365348190, 785 clinicians
Promedica Multi Specialty PhysiciansGroup PAC ID 7113182809, 269 clinicians

Practice addresses (Care Compare)

2142 N Cove Blvd
Toledo, OH 43606-3895
Phone (419) 291-4000

2901 N Reynolds Rd
Toledo, OH 43606
Phone (419) 578-7700

5200 Harroun Rd
Sylvania, OH 43560-2168
Phone (419) 824-1444

5308 Harroun Rd
Sylvania, OH 43560-2190

Hospital & facility affiliations

  • Promedica Toledo Hospital Hospital, Toledo, OH, CCN 360068

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50.009453RXOHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Central Physicians CurrentSince Aug 1, 2025 Accepting new patients
Promedica Central Physicians Physician Assistant CurrentSince Aug 1, 2025 Accepting new patients

Locations

5300 Harroun Rd
Ste 280
Sylvania, OH 43560

5700 Monroe St
Sylvania, OH 43560
Phone (419) 473-6622

5308 Harroun Rd
Ste 280
Sylvania, OH 43560
Phone (419) 824-1888

100 Madison Ave
Toledo, OH 43604
Phone (567) 585-1964

2142 N Cove Blvd
Toledo, OH 43606
Phone (419) 291-1111

2109 Hughes Dr
Ste 450
Toledo, OH 43606
Phone (419) 251-3112

Organizations & group practices 3

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": "1725408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749686400000",
    "number": "1124853619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 HARROUN RD STE 280",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435602146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5308 HARROUN RD STE 280",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435602190",
            "telephone_number": "567-585-2080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LASICH",
        "first_name": "NICOLE",
        "middle_name": "RENEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-04",
        "last_updated": "2025-06-12",
        "certification_date": "2025-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.009453RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sylvania, OH

Sources for this page

Verify at the official NPI Registry.