NPIMap

Individual provider Active NPI

Paul Robert Nielsen, MD, MS

  • Family Medicine Physician
  • Wooster, OH
National Provider Identifier
1912187071
Registry record updated Jul 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
57-013174 Issued in OH
Practice address
128 E Milltown Rd
Suite 105
Wooster, OH 44691-6109
Phone
(330) 345-8060
Fax
(330) 345-5983
NPI assigned
Nov 6, 2007
Last updated
Jul 15, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 57-013174 OH Primary

Addresses

Primary practice location

128 E Milltown Rd
Suite 105
Wooster, OH 44691-6109

Mailing address

128 E Milltown Rd
Suite 105
Wooster, OH 44691-6109
Phone (330) 345-8060

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100818000403 OH Practitioner - Family Practice 0941334510 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Milltown Family Physicians, Inc.Group PAC ID 5496891749, 8 clinicians
Bloomington Medical Services LLCGroup PAC ID 9032297627, 106 clinicians

Practice addresses (Care Compare)

128 E Milltown Rd
Suite 105
Wooster, OH 44691-1276
Phone (330) 345-8060

1761 Beall Ave
Wooster, OH 44691-2342
Phone (330) 263-8326

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions16
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Master of Science

State licenses

LicenseStateTypeSpecialty
57-013174OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bloomington Medical Services LLC CurrentSince Sep 1, 2016 Accepting new patients
Milltown Family Physicians, Inc. Family Medicine CurrentSince Jul 1, 2012 Accepting new patients
Smithville Western Inc. Past Accepting new patients
Progressive Wooster LLC Past Accepting new patients
Progressive Pines, LLC Past Accepting new patients

Locations

128 E Milltown Rd
Ste 105
Wooster, OH 44691
Phone (330) 345-8060

1761 Beall Ave
Wooster, OH 44691
Phone (330) 263-8100

Interoperability endpoints

  • Direct secure messaging: paulnielsen@mfpi.allscriptsdirect.net

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Avenue at WoosterWooster, OH, CCN 366463 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Feb 15, 2018
Feb 15, 2018

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1194307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279152000000",
    "number": "1912187071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 E MILLTOWN RD",
            "address_2": "SUITE 105",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446916109",
            "telephone_number": "330-345-8060",
            "fax_number": "330-345-5983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 E MILLTOWN RD",
            "address_2": "SUITE 105",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446916109",
            "telephone_number": "330-345-8060",
            "fax_number": "330-345-5983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIELSEN",
        "first_name": "PAUL",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "MD, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-06",
        "last_updated": "2010-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "57-013174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wooster, OH

Sources for this page

Verify at the official NPI Registry.