Nicole M Fornalski, PSYD

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

P.08416 Issued in OH

Practice address

480 Medical Center Dr
Columbus, OH 43210-1229

Phone

(614) 293-7604

Fax

(614) 293-3809

NPI assigned

Feb 28, 2023

Last updated

May 16, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Osu Physical Medicine and Rehabilitation LLCGroup PAC ID 7012960644, 35 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ohio State University State Health System Hospital, Columbus, OH, CCN 360085

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nfornalski1002378@direct.osumc.edu

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.

• Osu Physical Medicine and Rehabilitation, LLC

  • Physical Medicine & Rehabilitation Physician
  • Columbus, OH
  • NPI 1003029455
  Medicare reassignment Care Compare group NPD

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

• Ohio State University Hospitals

  dba Ohio State University Dodd Rehabilitation Hospital

  • Rehabilitation Hospital Unit
  • Columbus, OH
  • NPI 1184723637
  Care Compare affiliation
• Ohio State University Hospitals

  • General Acute Care Hospital
  • Columbus, OH
  • NPI 1447359997
  Care Compare affiliation
• Ohio State University Hospitals

  dba Ohio State University Harding Hospital

  • Psychiatric Hospital Unit
  • Columbus, OH
  • NPI 1790876183
  Care Compare affiliation

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

{
    "created_epoch": "1677542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684195200000",
    "number": "1942909817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 ACKERMAN RD STE 2120",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432021559",
            "telephone_number": "614-293-7604",
            "fax_number": "614-293-3809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 MEDICAL CENTER DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432101229",
            "telephone_number": "614-293-7604",
            "fax_number": "614-293-3809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORNALSKI",
        "first_name": "NICOLE",
        "middle_name": "M",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-28",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "OH",
            "license": "P.08416",
            "primary": true
        },
        {
            "code": "103TR0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Rehabilitation",
            "state": "OH",
            "license": "P.08416",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0015860",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heather R Forman, DPT
• Kelly Ann Forman, LSW
• Michael A Forman, PHD
• Nancy Walker Forman, PHD
• Patricia R Forman, M.D.
• Ella Mae Forney
• Nikkeya Forney, LPN
• Dorshalle Forrest-Russell
• Adrah Forrest
• Amanda Forrest, PHARMD, RPH

• Clinical Neuropsychologist in Columbus, OH
• Providers in Columbus, OH by specialty
• Clinical Neuropsychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.