Individual provider Active NPI

Brenda Nichols-Omiecinski, CRNA

  • Certified Registered Nurse Anesthetist
  • Chardon, OH
National Provider Identifier
1780637041
Registry record updated Jan 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN166962 Issued in OH
Practice address
13207 Ravenna Rd
Chardon, OH 44024-7032
Phone
(440) 285-6000
NPI assigned
May 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN166962 OH
Certified Registered Nurse Anesthetist 367500000X RN166962 OH Primary

Addresses

Primary practice location

13207 Ravenna Rd
Chardon, OH 44024-7032

Mailing address

PO Box 526
Novelty, OH 44072-0526
Phone (440) 285-6000

Other identifiers 8

IdentifierTypeStateIssuer
000000516002OtherOHANTHEM
750937OtherOHBUCKEYE MEDICAID
P00403006OtherOHMEDICARE RAILROAD
7516119OtherOHAETNA
000000221285OtherOHUNISON
0583328OtherOHBCMH
2389339MedicaidOH
415014OtherOHWELLCARE MEDICAID

Other names 1

  • Brenda Nichols Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070326000137 OH Practitioner - Certified Registered Nurse Anesthetist (Crna) 0143324509 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
91.15 of 100Reported as apm
Quality
82.31
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN166962OHMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Erie Sedation Associates, LLC Nurse Anesthetist, Certified Registered CurrentSince Nov 25, 2024 Accepting new patients
University Hospitals Medical Group Inc CurrentSince May 1, 2007 Accepting new patients
Anesthesia Dynamics LLC Nurse Anesthetist, Certified Registered CurrentSince Mar 6, 2024 Accepting new patients
University Hospitals Cleveland Medical Center Past Accepting new patients

Locations

8185 Washington St
Ste 6
Chagrin Falls, OH 44023
Phone (440) 708-0582

13207 Ravenna Rd
Chardon, OH 44024
Phone (440) 285-5004

11100 Euclid Ave
Cleveland Heights, OH 44106

158 W Main Rd
Ste 203
Conneaut, OH 44030
Phone (440) 285-2960

75 Sylvania Dr
Dayton, OH 45440
Phone (937) 320-5050

9000 N Main St
Ste 405
Englewood, OH 45415
Phone (937) 320-5050

6847 N Chestnut St
Ravenna, OH 44266
Phone (330) 296-9606

3605 Warrensville Center Rd
#R
Shaker Heights, OH 44122

1611 S Green Rd
Ste 120
South Euclid, OH 44121
Phone (440) 708-0582

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.

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736467200000",
    "number": "1780637041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 526",
            "city": "NOVELTY",
            "state": "OH",
            "postal_code": "440720526",
            "telephone_number": "440-285-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13207 RAVENNA RD",
            "city": "CHARDON",
            "state": "OH",
            "postal_code": "440247032",
            "telephone_number": "440-285-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS-OMIECINSKI",
        "first_name": "BRENDA",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-18",
        "last_updated": "2025-01-10",
        "certification_date": "2025-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN166962",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OH",
            "license": "RN166962",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000516002",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUCKEYE MEDICAID",
            "identifier": "750937",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00403006",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7516119",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNISON",
            "identifier": "000000221285",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCMH",
            "identifier": "0583328",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2389339",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE MEDICAID",
            "identifier": "415014",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRENDA",
            "last_name": "NICHOLS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Chardon, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.