Individual provider Active NPI

Nicholas Bloxsom

  • Counselor
  • Akron, OH
National Provider Identifier
1700458726
Registry record updated Jul 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
C2002866-T Issued in OH
Practice address
640 W Market St
Akron, OH 44303-1465
Phone
(330) 762-5425
NPI assigned
Jul 12, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X C2002866-T OH Primary

Addresses

Primary practice location

640 W Market St
Akron, OH 44303-1465

Mailing address

640 W Market St
Akron, OH 44303-1465

Other identifiers 1

IdentifierTypeStateIssuer
C2002866-TOtherOHCOUNSELOR IN TRAINING

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240708002418 OH Practitioner - Mental Health Counselor 8224573829 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
C2002866-TOHMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
Coleman Professional Services, Inc. CurrentSince May 12, 2024 Accepting new patients

Locations

2421 13th St NW
Canton, OH 44708
Phone (330) 452-6000

2600 6th St SW
Canton, OH 44710
Phone (330) 363-2180

624 Market Ave N
Canton, OH 44702
Phone (330) 454-7066

5982 Rhodes Rd
Kent, OH 44240
Phone (330) 676-6875

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1626048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626048000000",
    "number": "1700458726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 W MARKET ST",
            "city": "AKRON",
            "state": "OH",
            "postal_code": "443031465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 W MARKET ST",
            "city": "AKRON",
            "state": "OH",
            "postal_code": "443031465",
            "telephone_number": "330-762-5425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOXSOM",
        "first_name": "NICHOLAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-12",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OH",
            "license": "C2002866-T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COUNSELOR IN TRAINING",
            "identifier": "C2002866-T",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Akron, OH

Sources for this page

Verify at the official NPI Registry.