Individual provider Active NPI

Laura Nicoll, MD

  • Family Medicine Physician
  • Monroe, NY
National Provider Identifier
1184611840
Registry record updated Oct 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
227750 Issued in NY
Practice address
855 State Route 17M
Monroe, NY 10950-1600
Phone
(845) 703-6999
Fax
(845) 703-6297
NPI assigned
Sep 28, 2005
Last updated
Oct 12, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 227750 NY Primary

Addresses

Primary practice location

855 State Route 17M
Monroe, NY 10950-1600

Mailing address

155 Crystal Run Rd
Middletown, NY 10941-4028
Phone (845) 703-6999

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address laura.nicollmd.p1@direct.crystalrun.nextgenshare.com Direct

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
I20091217000420 NY Practitioner - Family Practice 4688714991 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
State University of Ny Upstate Medical University, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

300 Crystal Run Rd
Middletown, NY 10941-4069
Phone (845) 692-6999

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
227750NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Crystal Run Healthcare Physicians LLP CurrentSince Jul 30, 2003 Accepting new patients
Crystal Run Healthcare Physicians LLP Family Medicine CurrentSince Jul 30, 2003 Accepting new patients

Locations

7 Hatfield Ln
Goshen, NY 10924
Phone (718) 904-2965

155 Crystal Run Rd
Middletown, NY 10941

300 Crystal Run Rd
Middletown, NY 10941
Phone (845) 692-6999

855 State Route 17M
Monroe, NY 10950
Phone (845) 615-6999

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 2

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.

Hospital & facility affiliations 4

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": "1127865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602460800000",
    "number": "1184611840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 CRYSTAL RUN RD",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109414028",
            "telephone_number": "845-703-6999",
            "fax_number": "845-703-6297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 STATE ROUTE 17M",
            "city": "MONROE",
            "state": "NY",
            "postal_code": "109501600",
            "telephone_number": "845-703-6999",
            "fax_number": "845-703-6297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICOLL",
        "first_name": "LAURA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-28",
        "last_updated": "2020-10-12",
        "certification_date": "2020-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "227750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "laura.nicollmd.p1@direct.crystalrun.nextgenshare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "855 State Route 17M",
            "city": "Monroe",
            "state": "NY",
            "country_code": "US",
            "postal_code": "109501600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Monroe, NY

Sources for this page

Verify at the official NPI Registry.