Jeffrey R. Nichols, DO

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

69172-21 Issued in WI

Practice address

1000 Mineral Point Ave
Janesville, WI 53548

Phone

(608) 756-6611

Fax

(608) 756-6177

NPI assigned

Apr 23, 2015

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 WI, IL2 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

Emergency Medicine

Education

Midwestern University, Chicago College of Osteopathic Med, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mercy Health System CorporationGroup PAC ID 7416860440, shared by 14 NPIs, 749 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Health System Corp Hospital, Janesville, WI, CCN 520066

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jnichols48442@direct.mhemail.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.

• Mercy Health System Corporation

  • Multi-Specialty Clinic/Center
  • Janesville, WI
  • NPI 1598718603

  IL

  Medicare reassignment NPD
• Mercy Health System Corporation

  • Critical Access Hospital
  • Lake Geneva, WI
  • NPI 1699728550
  Medicare reassignment NPD
• Mercy Harvard Hospital Inc

  • Critical Access Hospital
  • Harvard, IL
  • NPI 1427001445
  Medicare reassignment NPD
• Rockford Health Physicians

  • Multi-Specialty Clinic/Center
  • Rockford, IL
  • NPI 1043242886
  Medicare reassignment NPD
• Mercy Health System Corporation

  • General Acute Care Hospital
  • Janesville, WI
  • NPI 1093768962
  NPD
• Mercy Harvard Hospital Inc

  • Skilled Nursing Facility
  • Harvard, IL
  • NPI 1124195557
  NPD

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

• Mercy Health System Corporation

  • General Acute Care Hospital
  • Janesville, WI
  • NPI 1093768962
  Care Compare affiliation

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

{
    "created_epoch": "1429747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536710400000",
    "number": "1316334683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 MINERAL POINT AVE",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535482940",
            "telephone_number": "608-756-6611",
            "fax_number": "608-756-6177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 MINERAL POINT AVE",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "53548",
            "telephone_number": "608-756-6611",
            "fax_number": "608-756-6177"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "530 NE Glen Oak Ave # Sfnb2624",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "IL",
            "postal_code": "616370001",
            "country_code": "US",
            "telephone_number": "309-655-6710",
            "fax_number": "309-624-9887",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "JEFFREY",
        "middle_name": "R.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-23",
        "last_updated": "2018-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036-144477",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "69172-21",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1316334683",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSWI",
            "identifier": "1316334683",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MERCYCARE INSURANCE",
            "identifier": "4919",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WI MEDICARE",
            "identifier": "K400494086",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lawrence L Neuman Jr., MD
• Norman R Newcomb, MD
• Dorothy Newmark, MD
• Hung Nguyen
• Karl A Nibbelink, MD
• Ryan Nichols, DC
• Alfred C Nicolosi, MD
• Brandon James Niebuhr
• David Nilsen, D.O.
• Sheila Kay Nitz, LPN

• Emergency Medicine Physician in Janesville, WI
• Providers in Janesville, WI by specialty
• Emergency Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2018; 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.