Individual provider Active NPI

Nicholas Gidosh

  • Student in an Organized Health Care Education/Training Program
  • Big Rapids, MI
National Provider Identifier
1881081461
Registry record updated Apr 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1124 S State St
Big Rapids, MI 49307-2256
Phone
(231) 591-2020
Fax
(231) 591-3991
NPI assigned
Apr 21, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

1124 S State St
Big Rapids, MI 49307-2256

Mailing address

1124 S State St
Big Rapids, MI 49307-2256
Phone (231) 591-2020

Other identifiers 2

IdentifierTypeStateIssuer
386005159MedicaidMI
900E47602OtherMIBLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170123000216 PA Practitioner - Optometry 2163737438 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Drexel UniversityGroup PAC ID 5496664740, 80 clinicians

Practice addresses (Care Compare)

1200 W Godfrey Ave
Philadelphia, PA 19141-3323
Phone (215) 276-6000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Drexel University CurrentSince Jan 5, 2025 Accepting new patients
Drexel University Current Accepting new patients
Drexel University CurrentSince Dec 1, 2016 Accepting new patients
Drexel University CurrentSince Jan 5, 2025 Accepting new patients
Salus University Hearing Vision Balance Clinic CurrentSince Dec 1, 2016 Accepting new patients
Pennsylvania College of Optometry Past Accepting new patients

Locations

1427 Vine St
Fl 8
Philadelphia, PA 19102
Phone (215) 762-6660

1427 Vine St
Fl 2
Philadelphia, PA 19102
Phone (215) 762-2530

7630 Germantown Ave
Ste 4
Philadelphia, PA 19118
Phone (215) 276-6000

1200 W Godfrey Ave
Philadelphia, PA 19141
Phone (215) 276-6000

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: nicholas.gidosh.p1@direct.salusuhealth.nextgenshare.com

Organizations & group practices 6

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": "1429574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429574400000",
    "number": "1881081461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1124 S STATE ST",
            "city": "BIG RAPIDS",
            "state": "MI",
            "postal_code": "493072256",
            "telephone_number": "231-591-2020",
            "fax_number": "231-591-3991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 S STATE ST",
            "city": "BIG RAPIDS",
            "state": "MI",
            "postal_code": "493072256",
            "telephone_number": "231-591-2020",
            "fax_number": "231-591-3991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIDOSH",
        "first_name": "NICHOLAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-21",
        "last_updated": "2015-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "386005159",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "900E47602",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Big Rapids, MI

Sources for this page

Verify at the official NPI Registry.