Individual provider Active NPI

Nelson Nicolasora, M.D.

  • Infectious Disease Physician
  • Toledo, OH
National Provider Identifier
1407974959
Registry record updated Oct 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
35091813 Issued in OH
Practice address
2222 Cherry St
Suite 1400
Toledo, OH 43608-2673
Phone
(419) 251-4787
Fax
(419) 251-7817
NPI assigned
Mar 26, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301088708 MI
Infectious Disease Physician 207RI0200X 35091813 OH Primary

Addresses

Primary practice location

2222 Cherry St
Suite 1400
Toledo, OH 43608-2673

Mailing address

2222 Cherry St
Suite 1400
Toledo, OH 43608-2673
Phone (419) 251-4787

Other identifiers 1

IdentifierTypeStateIssuer
2853907MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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 1

Enrollment IDStateProvider typePAC IDDetails
I20190304002751 AZ Practitioner - Infectious Disease 6709951247 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Infectious Disease
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Banner - University Physician Specialists LLCGroup PAC ID 5991008054, 343 clinicians

Practice addresses (Care Compare)

1111 E McDowell Rd
Phoenix, AZ 85006-2612
Phone (602) 839-2000

1300 N 12TH St
Suite 508
Phoenix, AZ 85006-2849
Phone (602) 839-3927

1441 N 12TH St
Phoenix, AZ 85006-2837
Phone (844) 242-4664

Hospital & facility affiliations

  • Banner - University Medical Center Phoenix Hospital, Phoenix, AZ, CCN 030002

Merit-based Incentive Payment System (MIPS)

Final score
82.85 of 100Reported as group
Quality
69.75
Promoting interoperability
98
Improvement activities
40
Cost
68.18

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301088708MIMDInternal Medicine Physician
35091813OHMDInfectious Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Banner - University Physician Specialists LLC CurrentSince Dec 1, 2018 Accepting new patients
Banner - University Physician Specialists LLC CurrentSince Dec 1, 2018 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

1441 N 12th St
Fl 3
Phoenix, AZ 85006
Phone (602) 521-5700

1300 N 12th St
Ste 508
Phoenix, AZ 85006
Phone (602) 839-3927

1441 N 12th St
Fl 2
Phoenix, AZ 85006
Phone (602) 521-5180

1441 N 12th St
Fl 2AND3
Phoenix, AZ 85006

1111 E McDowell Rd
Phoenix, AZ 85006
Phone (602) 239-2000

1300 N 12th St
Ste 312
Phoenix, AZ 85006
Phone (602) 279-5055

Organizations & group practices 3

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 1

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": "1174867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350432000000",
    "number": "1407974959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 CHERRY ST",
            "address_2": "SUITE 1400",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436082673",
            "telephone_number": "419-251-4787",
            "fax_number": "419-251-7817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 CHERRY ST",
            "address_2": "SUITE 1400",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436082673",
            "telephone_number": "419-251-4787",
            "fax_number": "419-251-7817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICOLASORA",
        "first_name": "NELSON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-26",
        "last_updated": "2012-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301088708",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "OH",
            "license": "35091813",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2853907",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.