Individual provider Active NPI

Nicholas Frank Kotsonis, MD

  • Family Medicine Physician
  • Wooster, OH
National Provider Identifier
1487922241
Registry record updated Aug 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35.132816 Issued in OH
Practice address
1761 Beall Ave
Wooster, OH 44691-2342
Phone
(330) 263-8428
NPI assigned
Dec 8, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MT209091 PA
Surgery Physician 208600000X 57.019955 OH
Family Medicine Physician 207Q00000X 35.132816 OH Primary

Addresses

Primary practice location

1761 Beall Ave
Wooster, OH 44691-2342

Mailing address

56 Joanne Dr
Latrobe, PA 15650-1066
Phone (513) 377-0006

Other practice location 1

56 Joanne Dr
Latrobe, PA 15650-1066
Phone (513) 377-0006

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180703003207 OH Practitioner - Family Practice 0749587178 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Wisconsin, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bloomington Medical Services LLCGroup PAC ID 9032297627, 106 clinicians

Practice addresses (Care Compare)

1761 Beall Ave
Wooster, OH 44691-2342
Phone (330) 202-5700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.09 of 100Reported as group
Quality
59.24
Promoting interoperability
99
Improvement activities
40
Cost
78.55

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
57.019955OHMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bloomington Medical Services LLC CurrentSince Aug 1, 2018 Accepting new patients
City of Wooster Past Accepting new patients

Locations

1761 Beall Ave
Wooster, OH 44691
Phone (330) 263-8100

1761 Beall Ave
Ofc
Wooster, OH 44691
Phone (330) 202-5700

Organizations & group practices 2

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": "1323302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535587200000",
    "number": "1487922241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56 JOANNE DR",
            "city": "LATROBE",
            "state": "PA",
            "postal_code": "156501066",
            "telephone_number": "513-377-0006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1761 BEALL AVE",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446912342",
            "telephone_number": "330-263-8428"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "56 Joanne Dr",
            "address_purpose": "LOCATION",
            "city": "Latrobe",
            "state": "PA",
            "postal_code": "156501066",
            "country_code": "US",
            "telephone_number": "513-377-0006",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOTSONIS",
        "first_name": "NICHOLAS",
        "middle_name": "FRANK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-12-08",
        "last_updated": "2018-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MT209091",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "57.019955",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35.132816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wooster, OH

Sources for this page

Verify at the official NPI Registry.