Nicholas B Countryman, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

01069284A Issued in IN

Practice address

7910 N Shadeland Ave
Indianapolis, IN 46250-2041

Phone

(317) 516-5000

Fax

(317) 516-5146

NPI assigned

May 29, 2008

Last updated

Apr 5, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

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

Specialty

Dermatology

Education

Yale University School of Medicine, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dawes Fretzin Dermatology Group, LLCGroup PAC ID 8820990872, 20 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

85.03 of 100Reported as group

Quality

68.51

Promoting interoperability

94

Improvement activities

40

Cost

86.6

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Dawes Fretzin Dermatology Group, LLC

  • Dermatology Physician
  • Indianapolis, IN
  • NPI 1932188331
  Medicare reassignment Care Compare group NPD
• Skin Surgery Center PA

  dba The Skin Surgery Center of Charleston

  • MOHS-Micrographic Surgery Physician
  • Mount Pleasant, SC
  • NPI 1851810279
  NPD (past)

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

{
    "created_epoch": "1212019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617580800000",
    "number": "1538327309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10507 HYDE PARK",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460328300",
            "telephone_number": "317-853-6227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7910 N SHADELAND AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502041",
            "telephone_number": "317-516-5000",
            "fax_number": "317-516-5146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COUNTRYMAN",
        "first_name": "NICHOLAS",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-05-29",
        "last_updated": "2021-04-05",
        "certification_date": "2021-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NC",
            "license": "2009-00203",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "IN",
            "license": "01069284A",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NC",
            "license": "2009-00203",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IN",
            "license": "01069284A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ncountryman@directaddress.net",
            "affiliation": "N",
            "address_1": "7910 N Shadeland Ave",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462502041",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Carly Taylor Count, DDS
• Cheri Counterman, LCSW
• Country Charm Village LLC
• Christopher K. Countryman, LCSW
• Cynthia J Countryman, ARNP
• Cournoyer Counseling Inc
• Catherine H Cournoyer, LCSW
• Roger Michael Cournoyer, MD
• Courteous Mav
• Courter Communications, LLC

• Dermatology Physician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Dermatology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2021; 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.