Nicole Katherine Brandstrup, PC-PROV, ATR-BC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

C.1000106.PROV. Issued in OH

Practice address

3130 Executive Pkwy FL 8
Toledo, OH 43606-5530

Phone

(419) 720-9000

Fax

(419) 720-9002

NPI assigned

Jan 5, 2012

Sex

Female

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

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mercy Health Physicians North Specialty Care LLCGroup PAC ID 1951707884, 345 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Mercy Health Physicians North Specialty Care LLC

  • Surgery Physician
  • Toledo, OH
  • NPI 1306468418
  Medicare reassignment Care Compare group NPD
• Mercy Health Physicians North Specialty Care LLC

  • Customized Equipment (DME)
  • Toledo, OH
  • NPI 1235891672
  NPD

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

{
    "created_epoch": "1325721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325721600000",
    "number": "1174893267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3130 EXECUTIVE PKWY FL 8",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436065530",
            "telephone_number": "419-720-9000",
            "fax_number": "419-720-9002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3130 EXECUTIVE PKWY FL 8",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436065530",
            "telephone_number": "419-720-9000",
            "fax_number": "419-720-9002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANDSTRUP",
        "first_name": "NICOLE",
        "middle_name": "KATHERINE",
        "name_prefix": "Ms.",
        "credential": "PC-PROV, ATR-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-01-05",
        "last_updated": "2012-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "C.1000106.PROV.",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COUNSELOR LICENSE",
            "identifier": "C.1000106.PROV.",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jade Symone Branch, LPC
• Tamara Cendra Branche
• Ryan Hunter Brandeberry
• Madeline Rose Brandewie
• Jacob Phillip Brandman, DC
• Diane Sue Brandt, RN
• Laura M Brandt, LPN
• Tasha Brandt, MSW, LSW
• Jayla Brantley
• Balhinder Singh Brar, M.D.

• Professional Counselor in Toledo, OH
• Providers in Toledo, OH by specialty
• Professional Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2012; 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.