Nico Mousdicas, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

01061689A Issued in IN

Practice address

755 W Carmel Dr
Suite 101
Carmel, IN 46032-5877

Phone

(317) 846-2396

Fax

(317) 846-1699

NPI assigned

Aug 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in IN

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

Specialty

Dermatology

Education

Other, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lifetime Skin Care Centers, LLCGroup PAC ID 1254306574, 6 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Henry County Memorial Hospital Hospital, New Castle, IN, CCN 150030

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nmousdicas@lscc.emadirect.md

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.

• Lifetime Skin Care Centers, LLC

  dba Lifetime Skin Care Centers

  • Dermatology Physician
  • Muncie, IN
  • NPI 1902861016
  Medicare reassignment Care Compare group NPD

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

• Henry County Memorial Hospital

  • General Acute Care Hospital
  • New Castle, IN
  • NPI 1356428429
  Care Compare affiliation

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392681600000",
    "number": "1144238650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "address_2": "STE 130 PROVIDER ENROLLMENT",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 W CARMEL DR",
            "address_2": "SUITE 101",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460325877",
            "telephone_number": "317-846-2396",
            "fax_number": "317-846-1699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUSDICAS",
        "first_name": "NICO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-03",
        "last_updated": "2014-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IN",
            "license": "01061689A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200488150",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000334111",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000563670",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anush Raghunandan Motaganahalli
• Anna Liza Motilla
• Mouchaham Dentistry, LLC
• Nicholas Mouchaham, DMD
• Derek Duane Mounsey, DO, MHA
• Moving Forward DME
• Moving Mountains Physical Therapy & Performance LLC
• Laurie Ann Moyer, LMHC, LCAC, ATR
• Erin Mrakovich, LCSW
• MTG Capital LLC

• Dermatology Physician in Carmel, IN
• Providers in Carmel, IN by specialty
• Dermatology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2014; 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.