Central Ohio Medical Management LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35.086704 Issued in OH

Legal business name

CENTRAL OHIO MEDICAL MANAGEMENT LLC

Practice address

1755 Lancaster Ave
Reynoldsburg, OH 43068-3108

Phone

(614) 577-1948

Fax

(614) 577-1948

NPI assigned

Feb 8, 2018

Organization subpart

No

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

Authorized official

Name

Gina Marie Nichols, MDNPI 1821026451

Title

Ceo

Phone

(614) 577-1948

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gina Marie Nichols, MD

  • Family Medicine Physician
  • Pickerington, OH
  • NPI 1821026451
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1518048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524182400000",
    "number": "1962901678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 513",
            "city": "PICKERINGTON",
            "state": "OH",
            "postal_code": "431470513",
            "telephone_number": "614-577-1948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1755 LANCASTER AVE",
            "city": "REYNOLDSBURG",
            "state": "OH",
            "postal_code": "430683108",
            "telephone_number": "614-577-1948",
            "fax_number": "614-577-1948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL OHIO MEDICAL MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-08",
        "last_updated": "2018-04-20",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "GINA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "614-577-1948",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35.086704",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2611267",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jillian Caufield
• Tiffany Causey
• Kylie Ceglio
• Celeste Healthcare
• Central Ohio Hearing Aid Center
• Central Ohio Service Dogs
• Yavawn Channakhone, RN
• Khanthaly Theresa Chanthasene, RN
• Adrienne B. Chatters, O.D.
• Devin T Chavis

• Family Medicine Physician in Reynoldsburg, OH
• Providers in Reynoldsburg, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.