NPIMap

Individual provider Active NPI

Marc Sheldon Nusholtz, D.O.

  • Internal Medicine Physician
  • Logansport, IN
National Provider Identifier
1245368646
Registry record updated Nov 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
02001520A Issued in IN
Practice address
1101 Michigan Ave
Logansport, IN 46947-1528
Phone
(574) 753-1302
NPI assigned
Feb 28, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2011

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 5101007102 MI
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 5101007102 MI
Pulmonary Disease Physician 207RP1001X 5101007102 MI
Internal Medicine Physician 207R00000X 02001520A IN Primary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 02001520A IN
Pulmonary Disease Physician 207RP1001X 02001520A IN

Addresses

Primary practice location

1101 Michigan Ave
Logansport, IN 46947-1528

Mailing address

1101 Michigan Ave
Logansport, IN 46947-1528
Phone (574) 753-1302

Other identifiers 2

IdentifierTypeStateIssuer
000000720342OtherINANTHEM BLUE CROSS
200174470MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1922WVMDGeneral Practice Dentistry
02001520AINMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Oak Hill Clinic Corp Past Accepting new patients
Kelly Medical Services Corporation LLC Internal Medicine Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320192000000",
    "number": "1245368646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 MICHIGAN AVE",
            "city": "LOGANSPORT",
            "state": "IN",
            "postal_code": "469471528",
            "telephone_number": "574-753-1302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 MICHIGAN AVE",
            "city": "LOGANSPORT",
            "state": "IN",
            "postal_code": "469471528",
            "telephone_number": "574-753-1302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NUSHOLTZ",
        "first_name": "MARC",
        "middle_name": "SHELDON",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-28",
        "last_updated": "2011-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5101007102",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "MI",
            "license": "5101007102",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MI",
            "license": "5101007102",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "02001520A",
            "primary": true
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "IN",
            "license": "02001520A",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "IN",
            "license": "02001520A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS",
            "identifier": "000000720342",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200174470",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Logansport, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.