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Individual provider Active NPI

Charles J Nicely, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Columbus, OH
National Provider Identifier
1407858269
Registry record updated Nov 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
35.065134 Issued in OH
Practice address
3535 Olentangy River Rd
Columbus, OH 43214-3908
Phone
(614) 566-4945
Fax
(614) 263-1056
NPI assigned
Aug 11, 2005
Last updated
Nov 11, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 35.065134 OH Primary

Addresses

Primary practice location

3535 Olentangy River Rd
Columbus, OH 43214-3908

Mailing address

PO Box 20452
Corpath Cred
Columbus, OH 43220-0452
Phone (614) 457-8180

Other identifiers 1

IdentifierTypeStateIssuer
0926136MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070312000320 OH Practitioner - Pathology 2567404643 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Ohio State University College of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Corpath LTDGroup PAC ID 7315989498, 27 clinicians

Practice addresses (Care Compare)

3535 Olentangy River Rd
Columbus, OH 43214-3908
Phone (614) 566-4945

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.78 of 100Reported as group
Quality
85.63
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.065134OHMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Corpath LTD Anatomic Pathology & Clinical Pathology CurrentSince Nov 11, 1997 Accepting new patients

Locations

600 N Pickaway St
Circleville, OH 43113
Phone (614) 352-6479

111 S Grant Ave
Columbus, OH 43215
Phone (614) 461-3232

3535 Olentangy River Rd
Columbus, OH 43214
Phone (614) 566-1997

561 W Central Ave
Delaware, OH 43015
Phone (614) 566-9983

7500 Hospital Dr
Dublin, OH 43016
Phone (614) 544-8000

1375 Stringtown Rd
Grove City, OH 43123
Phone (614) 352-6479

921 E Franklin St
Kenton, OH 43326
Phone (419) 673-0761

1000 McKinley Park Dr
Marion, OH 43302
Phone (740) 383-8400

5100 W Broad St
New Rome, OH 43228
Phone (614) 544-1000

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668124800000",
    "number": "1407858269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 20452",
            "address_2": "CORPATH CRED",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432200452",
            "telephone_number": "614-457-8180",
            "fax_number": "614-583-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 OLENTANGY RIVER RD",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432143908",
            "telephone_number": "614-566-4945",
            "fax_number": "614-263-1056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICELY",
        "first_name": "CHARLES",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-11",
        "last_updated": "2022-11-11",
        "certification_date": "2022-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "OH",
            "license": "35.065134",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0926136",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.