Active NPI
Carol J Hicks, MD
- Family Medicine Physician
- Deshler, OH
National Provider Identifier
1376578575
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 35.053028
- Practice address
- 141 N Keyser Ave
Deshler, OH 43516-1111 - Phone
- (419) 278-2065
- Fax
- (419) 278-6500
- NPI assigned
- Jul 12, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 35.053028 | OH | Primary |
Addresses
Primary practice location
141 N Keyser Ave
Deshler, OH 43516-1111
Mailing address
745 Haskins Rd
Suite B
Bowling Green, OH 43402-1600
Phone (419) 353-7069
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0620699 | Medicaid | OH |
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35.053028 | OH | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lima Memorial Joint Operating Company | Past | Accepting new patients |
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.
-
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1462838400000",
"number": "1376578575",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "745 HASKINS RD",
"address_2": "SUITE B",
"city": "BOWLING GREEN",
"state": "OH",
"postal_code": "434021600",
"telephone_number": "419-353-7069",
"fax_number": "419-353-7076"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "141 N KEYSER AVE",
"city": "DESHLER",
"state": "OH",
"postal_code": "435161111",
"telephone_number": "419-278-2065",
"fax_number": "419-278-6500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HICKS",
"first_name": "CAROL",
"middle_name": "J",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-12",
"last_updated": "2016-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OH",
"license": "35.053028",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0620699",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Deshler, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.