Individual provider Active NPI

Nicole M Burgbacher, P.A.

  • Physician Assistant
  • Dayton, OH
National Provider Identifier
1619908381
Registry record updated Sep 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50002158 Issued in OH
Practice address
4160 Little York Rd
Suite 10
Dayton, OH 45414-5800
Phone
(937) 415-9100
Fax
(937) 415-9191
NPI assigned
Jul 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50002158 OH Primary

Addresses

Primary practice location

4160 Little York Rd
Suite 10
Dayton, OH 45414-5800

Mailing address

PO Box 713130
Cincinnati, OH 45271-0001
Phone (937) 415-9100

Other identifiers 1

IdentifierTypeStateIssuer
P00822690OtherOHRR MCR

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040915000849 OH Practitioner - Physician Assistant 3274500558 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4160 Little York Rd
Suite 10
Dayton, OH 45414-5803
Phone (937) 415-9100

7677 Yankee St
Suite 110
Centerville, OH 45459-3475
Phone (937) 428-0400

Hospital & facility affiliations

  • Wilson Memorial Hospital Hospital, Sidney, OH, CCN 360013

Merit-based Incentive Payment System (MIPS)

Final score
83.43 of 100Reported as group
Quality
70.97
Promoting interoperability
98
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2158OHMDChiropractor
50002158OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopedic Associates of SW Ohio, Inc CurrentSince May 15, 2008 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

4160 Little York Rd
Ste 10
Dayton, OH 45414
Phone 9374159100335

7677 Yankee St
Ste 110
Dayton, OH 45459
Phone (937) 401-6400

915 Michigan St
Sidney, OH 45365
Phone (937) 498-2311

300 3rd Ave
Sidney, OH 45365
Phone (937) 710-4786

Interoperability endpoints

  • Direct secure messaging: nicole.burgbacher@oaswo.eclinicaldirectplus.com

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": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347494400000",
    "number": "1619908381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 713130",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452710001",
            "telephone_number": "937-415-9100",
            "fax_number": "937-415-9191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4160 LITTLE YORK RD",
            "address_2": "SUITE 10",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454145800",
            "telephone_number": "937-415-9100",
            "fax_number": "937-415-9191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGBACHER",
        "first_name": "NICOLE",
        "middle_name": "M",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-05",
        "last_updated": "2012-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50002158",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MCR",
            "identifier": "P00822690",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.