Active NPI
Keith E Nichols, MD
- Surgery Physician
- Columbus, OH
National Provider Identifier
1730171778
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 35055973
- Practice address
- 500 Thomas LN
Suite 2C
Columbus, OH 43214-3902 - Phone
- (614) 566-2370
- Fax
- (614) 533-0436
- NPI assigned
- Aug 16, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 35055973 | OH | Primary |
Addresses
Primary practice location
500 Thomas LN
Suite 2C
Columbus, OH 43214-3902
Mailing address
5350 Frantz Rd
Dublin, OH 43016-4259
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0747740 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35055973 | OH | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ohiohealth Corporation | Past | Accepting new patients | |
| Lima Memorial Joint Operating Company | Past | Accepting new patients | |
| Columbus Surgical Specialists Inc | Surgery | Past | Accepting new patients |
Organizations & group practices 3
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.
-
dba Lima Memorial Health System
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
-
dba OhioHealth Physician Group, Inc
- Family Medicine Physician
- Columbus, OH
- NPI 1578545273
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1384128000000",
"number": "1730171778",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5350 FRANTZ RD",
"city": "DUBLIN",
"state": "OH",
"postal_code": "430164259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 THOMAS LN",
"address_2": "SUITE 2C",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432143902",
"telephone_number": "614-566-2370",
"fax_number": "614-533-0436"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "KEITH",
"middle_name": "E",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-16",
"last_updated": "2013-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "OH",
"license": "35055973",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0747740",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.