Jeffrey Scott Nicklas, MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

35.066875 Issued in OH

Practice address

1044 Belmont Ave
Youngstown, OH 44504-1006

Phone

(330) 480-3658

Fax

(330) 286-5396

NPI assigned

Aug 1, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in PA, OH2 enrollments

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 2

Specialty

Anesthesiology

Education

Other, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bel-Park Anesthesia Associates, Inc.Group PAC ID 8628974904, 158 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• MH St Joseph Warren Hospital Hospital, Warren, OH, CCN 360161

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jnicklas832535@direct.bsmhealth.org

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.

• Bel-Park Anesthesia Associates, Inc.

  • Anesthesiology Physician
  • Youngstown, OH
  • NPI 1508813528

  Anesthesiology, OH, PA

  Medicare reassignment Care Compare group NPD
• North American Partners in Anesthesia, Pennsylvania , LLC

  • Anesthesiology Physician
  • Melville, NY
  • NPI 1639137854

  Anesthesiology, PA

  Medicare reassignment NPD
• Upmc Community Medicine Inc

  • Internal Medicine Physician
  • Pittsburgh, PA
  • NPI 1588622294

  Anesthesiology

  NPD (past)

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

• Mercy Health Youngstown LLC

  • Clinical Medical Laboratory
  • Warren, OH
  • NPI 1538233309

  Hospital

  Care Compare affiliation
• Mercy Health Youngstown LLC

  • General Acute Care Hospital
  • Warren, OH
  • NPI 1629009964

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1185926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605052800000",
    "number": "1295925535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4135 BOARDMAN CANFIELD RD STE 101",
            "city": "CANFIELD",
            "state": "OH",
            "postal_code": "444069803",
            "telephone_number": "330-286-5330",
            "fax_number": "330-286-5396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1044 BELMONT AVE",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445041006",
            "telephone_number": "330-480-3658",
            "fax_number": "330-286-5396"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Fairfield Dr",
            "address_purpose": "LOCATION",
            "city": "Deneca",
            "state": "PA",
            "postal_code": "16346",
            "country_code": "US",
            "telephone_number": "814-676-7843",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "239 Edgewood Drive Ext",
            "address_purpose": "LOCATION",
            "city": "Transfer",
            "state": "PA",
            "postal_code": "161541817",
            "country_code": "US",
            "telephone_number": "330-286-5330",
            "fax_number": "330-286-5396",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICKLAS",
        "first_name": "JEFFREY",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-01",
        "last_updated": "2020-11-11",
        "certification_date": "2020-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "PA",
            "license": "MT190045",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "PA",
            "license": "MD443825",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OH",
            "license": "35.066875",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "4119641",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11176372",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0056821",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "227307",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Huong Thi Nguyen
• Nicholas P Depizzo DO Inc
• Sara Ashley Nicholas, D.O.
• Deborah J Nichols, C-NP
• Flores D Nichols
• Frances Micole Bognot Nifas
• Kelly Grove Nigro, M.D.
• Amanda K Niles, RN, LPN
• Niraj Niraula, MD
• Dennis Nisbett, RPH

• Anesthesiology Physician in Youngstown, OH
• Providers in Youngstown, OH by specialty
• Anesthesiology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2020; 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.