Individual provider Active NPI

Nichole Eileen Feller, PA-C

  • Physician Assistant
  • Lakewood, OH
National Provider Identifier
1306329487
Registry record updated Oct 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.005664RX Issued in OH
Practice address
14601 Detroit Ave
Lakewood, OH 44107-4205
Phone
(162) 375-5002
NPI assigned
Sep 13, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50.005664RX OH Primary

Addresses

Primary practice location

14601 Detroit Ave
Lakewood, OH 44107-4205

Mailing address

17600 Detroit Ave Apt 603
Lakewood, OH 44107-3440

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181101002952 OH Practitioner - Physician Assistant 1850644162 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cleveland ClinicGroup PAC ID 1850203555, 6,954 clinicians

Practice addresses (Care Compare)

14601 Detroit Ave
Lakewood, OH 44107-4205

8950 Euclid Ave
Cleveland, OH 44195-0001
Phone (216) 444-8950

9500 Euclid Ave
Cleveland, OH 44195-0001

Hospital & facility affiliations

  • Cleveland Clinic Hospital, Cleveland, OH, CCN 360180
  • Cleveland Clinic Avon Hospital Hospital, Avon, OH, CCN 360364
  • Fairview Hospital Hospital, Cleveland, OH, CCN 360077

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
50.005664RXOHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Cleveland Clinic Foundation CurrentSince Sep 26, 2018 Accepting new patients

Locations

9500 Euclid Ave
Cleveland, OH 44195
Phone (216) 442-1270

14601 Detroit Ave
Lakewood, OH 44107
Phone (216) 237-5500

2999 McMackin Rd
Madison, OH 44057
Phone (440) 428-1111

6801 Brecksville Rd
Ste 20
Seven Hills, OH 44131
Phone (216) 445-3363

Organizations & group practices 1

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.

Hospital & facility affiliations 3

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": "1536796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729814400000",
    "number": "1306329487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17600 DETROIT AVE APT 603",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "441073440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14601 DETROIT AVE",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "441074205",
            "telephone_number": "162-375-5002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FELLER",
        "first_name": "NICHOLE",
        "middle_name": "EILEEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-13",
        "last_updated": "2024-10-25",
        "certification_date": "2024-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.005664RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, OH

Sources for this page

Verify at the official NPI Registry.