Individual provider Active NPI

Nicole Van Horne, DO

  • Emergency Medicine Physician
  • Lansing, MI
National Provider Identifier
1255793667
Registry record updated Jul 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
5101025432 Issued in MI
Practice address
1215 E Michigan Ave
Lansing, MI 48912-1811
Phone
(517) 364-4140
NPI assigned
Mar 24, 2016
Last updated
Jul 1, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 34.012992 OH
Emergency Medicine Physician 207P00000X 5101025432 MI Primary

Addresses

Primary practice location

1215 E Michigan Ave
Lansing, MI 48912-1811

Mailing address

1215 E Michigan Ave
Lansing, MI 48912-1811
Phone (517) 364-4140

Other practice location 1

4000 Miamisburg Centerville Rd
Miamisburg, OH 45342-7615
Phone (937) 384-8791

Other practice location 2

321 E Harris St
Charlotte, MI 48813-1629
Phone (517) 364-4140

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20200806001090 MI Practitioner - Emergency Medicine 0749570810 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Ohio University, College of Osteopathic Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Epmg Southwest Michigan PLLCGroup PAC ID 2769719236, 45 clinicians

Practice addresses (Care Compare)

31 N Saint Joseph Ave
Niles, MI 49120-2207
Phone (954) 939-5000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34.012992OHMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Vituity - Michigan Em PC Emergency Medicine CurrentSince Oct 1, 2021 Accepting new patients
Epmg Southwest Michigan PLLC Emergency Medicine CurrentSince May 1, 2023 Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

321 E Harris St
Charlotte, MI 48813
Phone (517) 541-5840

1215 E Michigan Ave
Lansing, MI 48912
Phone (517) 336-8080

31 N Saint Joseph Ave
Niles, MI 49120
Phone (269) 428-2417

1234 Napier Ave
Saint Joseph, MI 49085
Phone (269) 982-4941

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 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": "1458777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593561600000",
    "number": "1255793667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 E MICHIGAN AVE",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489121811",
            "telephone_number": "517-364-4140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 E MICHIGAN AVE",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489121811",
            "telephone_number": "517-364-4140"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4000 Miamisburg Centerville Rd",
            "address_purpose": "LOCATION",
            "city": "Miamisburg",
            "state": "OH",
            "postal_code": "453427615",
            "country_code": "US",
            "telephone_number": "937-384-8791",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "321 E Harris St",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "MI",
            "postal_code": "488131629",
            "country_code": "US",
            "telephone_number": "517-364-4140",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAN HORNE",
        "first_name": "NICOLE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-24",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "34.012992",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "5101025432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lansing, MI

Sources for this page

Verify at the official NPI Registry.