Jacqueline Nicodemo

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

57.246584 Issued in OH

Practice address

700 Childrens Dr
Columbus, OH 43205

Phone

(614) 722-4411

NPI assigned

Mar 28, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jacqueline.nicodemo.1@6860.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/6860/brand/1/csg/1/fhir/r4

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.

• Pediatric Academic Association, Inc.

  • Pediatrics Physician
  • Columbus, OH
  • NPI 1063419943
  Medicare reassignment NPD
• Nationwide Children'S Hospital

  • Dental Clinic/Center
  • Columbus, OH
  • NPI 1407013964
  NPD (past)
• Olentangy Pediatrics, Inc.

  • Pediatrics Physician
  • Columbus, OH
  • NPI 1609842962
  NPD (past)

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

{
    "created_epoch": "1522195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529971200000",
    "number": "1750886115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 CHILDRENS DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432052664",
            "telephone_number": "614-722-4411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 CHILDRENS DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "43205",
            "telephone_number": "614-722-4411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICODEMO",
        "first_name": "JACQUELINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-28",
        "last_updated": "2018-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "57.246584",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Nicole Nickell, FNP
• Jennifer Nickens, FNP-C
• Shayla Nickerson
• Tiffany Alisha Nickie-Hull, PSY.D., LMHC
• Ellen Michelle Nicklaus
• Anne Nicol, LSW
• Kathleen Nicol, M.D.
• Audrey Nicolai
• Stefan Nicolau, M.D.
• Jeanne Marie Nicolette, DDS

• Pediatrics Physician in Columbus, OH
• Providers in Columbus, OH by specialty
• Pediatrics Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.