Active NPI
Nicholaus Reynolds
- Nurse Practitioner
- Cleveland, OH
National Provider Identifier
1801442132
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- APRN.CNP.025261
- Practice address
- 1001 Lakeside Ave E Ste 1000
Cleveland, OH 44114-1162 - Phone
- (216) 694-4080
- NPI assigned
- Aug 13, 2019
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | APRN.CNP.025261 | OH | Primary |
Addresses
Primary practice location
1001 Lakeside Ave E Ste 1000
Cleveland, OH 44114-1162
Mailing address
1001 Lakeside Ave E Ste 1000
Cleveland, OH 44114-1162
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | www.optum.com |
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: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260203003356 | OH | Order and Referring Only - Nurse Practitioner | 9436481454 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APRN.CNP.025261 | OH | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Optum Care Services Company | Nurse Practitioner | Past | Accepting new patients |
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.
-
- Family Nurse Practitioner
- Columbia, MD
- NPI 1912199415
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565654400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565654400000",
"number": "1801442132",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1001 LAKESIDE AVE E STE 1000",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441141162"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 LAKESIDE AVE E STE 1000",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441141162",
"telephone_number": "216-694-4080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNOLDS",
"first_name": "NICHOLAUS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-08-13",
"last_updated": "2019-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "OH",
"license": "APRN.CNP.025261",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "www.optum.com",
"affiliation": "N",
"address_1": "1001 Lakeside Ave E Ste 1000",
"city": "Cleveland",
"state": "OH",
"country_code": "US",
"postal_code": "441141162",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Cleveland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2019; 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.