Frederick Matthew Nista, OD

Key facts

NPI

1871514596

Entity type

Individual (NPI type 1)

Primary specialty

Optometrist 152W00000X

License

4901002465 (MI)

Practice address

1310 Cramer Circle
Pennock 506
Big Rapids, MI 49307-2738

Phone

(231) 591-2222

Fax

(231) 591-3991

NPI assigned

Jul 21, 2006

Sex

Male

Sole proprietor

No

Organizations & group practices 2

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.

• Ferris State University Ophthalmology Physician · Big Rapids, MI · NPI 1477574101
  NPD (past)
• Ferris State University Optometrist · Big Rapids, MI · NPI 1871510859
  NPD (past) OPTOMETRIST

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

HHS exclusion list flag

The National Provider Directory flags this NPI as appearing on an HHS exclusion list. Confirm with the OIG exclusions search.

Practice roles

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1871514596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 CRAMER CIRCLE",
            "address_2": "PENNOCK 506",
            "city": "BIG RAPIDS",
            "state": "MI",
            "postal_code": "493072738",
            "telephone_number": "231-591-2222",
            "fax_number": "231-591-3991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 CRAMER CIRCLE",
            "address_2": "PENNOCK 506",
            "city": "BIG RAPIDS",
            "state": "MI",
            "postal_code": "493072738",
            "telephone_number": "231-591-2222",
            "fax_number": "231-591-3991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISTA",
        "first_name": "FREDERICK",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901002465",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "FN002465",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADMINISTAR",
            "identifier": "078466001020",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4401859",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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