NPIMap

Individual provider Active NPI

Nicole Carroll, D.O.

  • Family Medicine Physician
  • Shippenville, PA
National Provider Identifier
1649593500
Registry record updated Jul 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS015672 Issued in PA
Practice address
21159 Paint Blvd
Suite 2
Shippenville, PA 16254-4023
Phone
(814) 226-6770
NPI assigned
Mar 8, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS015672 PA Primary

Addresses

Primary practice location

21159 Paint Blvd
Suite 2
Shippenville, PA 16254-4023

Mailing address

121 Doctors LN
Clarion, PA 16214-8515
Phone (814) 226-3470

Other identifiers 1

IdentifierTypeStateIssuer
1026314130003MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20111010000254 PA Practitioner - Family Practice 5597937862 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Lake Erie College of Osteopathic Medicine, Erie, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians
Butler Medical ProvidersGroup PAC ID 7416840160, 355 clinicians

Practice addresses (Care Compare)

2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238

24 Doctors LN
Suite 300
Clarion, PA 16214-8568
Phone (814) 226-6770

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Butler Medical Providers Family Medicine CurrentSince Apr 1, 2021 Accepting new patients
Butler Medical Providers CurrentSince Apr 1, 2021 Accepting new patients
Butler Medical Providers Current Accepting new patients
Butler Medical Providers Past Accepting new patients

Locations

371 Route 28
Brookville, PA 15825
Phone (814) 226-8800

127 Oneida Valley Rd
Ste 400
Butler, PA 16001
Phone (724) 431-0550

330 N Point Dr
Ste 200
Clarion, PA 16214
Phone (724) 284-4060

24 Doctors Ln
Ste 201
Clarion, PA 16214
Phone (833) 684-1898

24 Doctors Ln
Ste 202
Clarion, PA 16214
Phone (814) 226-2500

24 Doctors Ln
Ste 300
Clarion, PA 16214
Phone (724) 794-7923

Interoperability endpoints

  • Direct secure messaging: nicole.carroll@direct-address.net

Organizations & group practices 4

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 9

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": "1268006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341878400000",
    "number": "1649593500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 DOCTORS LN",
            "city": "CLARION",
            "state": "PA",
            "postal_code": "162148515",
            "telephone_number": "814-226-3470",
            "fax_number": "814-226-3479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21159 PAINT BLVD",
            "address_2": "SUITE 2",
            "city": "SHIPPENVILLE",
            "state": "PA",
            "postal_code": "162544023",
            "telephone_number": "814-226-6770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "NICOLE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-08",
        "last_updated": "2012-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS015672",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1026314130003",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shippenville, PA

Sources for this page

Verify at the official NPI Registry.