NPIMap

Individual provider Active NPI

Nicholas Walter Detore, M.D.

  • Internal Medicine Physician
  • Mentor, OH
National Provider Identifier
1942438197
Registry record updated Mar 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35.098967 Issued in OH
Practice address
9485 Mentor Ave
Suite 210
Mentor, OH 44060-4597
Phone
(440) 205-5892
Fax
(440) 205-5744
NPI assigned
Jun 26, 2009
Last updated
Mar 2, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35.098967 OH Primary

Addresses

Primary practice location

9485 Mentor Ave
Suite 210
Mentor, OH 44060-4597

Mailing address

9485 Mentor Ave
Suite 210
Mentor, OH 44060-4597
Phone (440) 205-5892

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address nicholas.detore@lhpg.eclinicaldirectplus.com Direct

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
I20120710000303 OH Practitioner - Internal Medicine 8527223981 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Northeastern Ohio University College of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lake Hospital System, Inc.Group PAC ID 6002713922, 92 clinicians

Practice addresses (Care Compare)

11100 Euclid Ave
Cleveland, OH 44106-1716

36500 Euclid Ave
Willoughby, OH 44094-4455
Phone (440) 516-0530

9485 Mentor Ave
Mentor, OH 44060-8723

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Hospital System, Inc Internal Medicine CurrentSince Jun 30, 2013 Accepting new patients
Lake Hospital System CurrentSince Jun 30, 2013 Accepting new patients
Lake Hospital System Inc Internal Medicine Current Accepting new patients
Lake Hospital System, Inc Internal Medicine Past Accepting new patients
Mentor Health and Rehabilitation Center, Inc. Past Accepting new patients
Concord Village Skilled Nursing & Rehabilitation, LTD Past Accepting new patients
Lake Hospital System Inc Past Accepting new patients

Locations

7590 Auburn Rd
Ste 14
Concord Township, OH 44077
Phone (440) 354-1899

9485 Mentor Ave
Ste 210
Mentor, OH 44060
Phone (440) 255-5571

10780 Kinsman Rd
Newbury, OH 44065
Phone (440) 564-5656

Interoperability endpoints

  • Direct secure messaging: ndetore37059@ehrdirect.uhhospitals.org
  • Direct secure messaging: nicholas.detore@lhpg.eclinicaldirectplus.com

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
Mentor Ridge Health and RehabilitationMentor, OH, CCN 366455 Skilled nursing facility Adp of the SNF Aug 31, 2017

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 7

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 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1245974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614643200000",
    "number": "1942438197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9485 MENTOR AVE",
            "address_2": "SUITE 210",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440604597",
            "telephone_number": "440-205-5892",
            "fax_number": "440-205-5744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9485 MENTOR AVE",
            "address_2": "SUITE 210",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440604597",
            "telephone_number": "440-205-5892",
            "fax_number": "440-205-5744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETORE",
        "first_name": "NICHOLAS",
        "middle_name": "WALTER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-26",
        "last_updated": "2021-03-02",
        "certification_date": "2021-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35.098967",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nicholas.detore@lhpg.eclinicaldirectplus.com",
            "affiliation": "N",
            "endpointDescription": "Baseline West Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "9485 Mentor Ave",
            "address_2": "Suite 210",
            "city": "Mentor",
            "state": "OH",
            "country_code": "US",
            "postal_code": "440604597",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mentor, OH

Sources for this page

Verify at the official NPI Registry.