Theodore J Nichols, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

35-045308 Issued in OH

Practice address

36100 Euclid Avenue #240
Willoughby, OH 44094

Phone

(440) 953-6294

Fax

(440) 918-4687

NPI assigned

Aug 21, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Lima Memorial Joint Operating Company

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614729600000",
    "number": "1689780934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7590 AUBURN ROAD, SUITE 014",
            "address_2": "ATTN: MED STAFF",
            "city": "CONCORD TWP",
            "state": "OH",
            "postal_code": "440779176",
            "telephone_number": "440-354-1899",
            "fax_number": "440-354-1845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36100 EUCLID AVENUE #240",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "44094",
            "telephone_number": "440-953-6294",
            "fax_number": "440-918-4687"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9485 Mentor Avenue",
            "address_2": "Suite 210",
            "address_purpose": "LOCATION",
            "city": "Mentor",
            "state": "OH",
            "postal_code": "44060",
            "country_code": "US",
            "telephone_number": "440-205-5836",
            "fax_number": "440-205-5854",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "THEODORE",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-21",
        "last_updated": "2021-03-03",
        "certification_date": "2021-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35-045308",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0547537",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "theodore.nichols@lhpg.eclinicaldirectplus.com",
            "affiliation": "N",
            "endpointDescription": "Baseline West Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "9485 Mentor Avenue",
            "address_2": "Suite 210",
            "city": "Mentor",
            "state": "OH",
            "country_code": "US",
            "postal_code": "44060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kenneth William Nevar, DDS
• New Pathways Group LLC
• Kate Brennan Newland, 17500000X
• Sara Newsome
• Kristen Michelle Nichols
• Niels William Nielsen, LISW
• Alisa Nieves
• Nightingale Vespa Adapted Advantage
• North Chagrin Sports Medicine
• Northeast Ohio Heart Associates LLC

• Internal Medicine Physician in Willoughby, OH
• Providers in Willoughby, OH by specialty
• Internal Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.