Active NPI
Nicholas Fly
- Mental Health Counselor
- Woodbine, IA
National Provider Identifier
1972285419
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 118555
- Practice address
- 61 4TH St
Woodbine, IA 51579-1259 - Phone
- (712) 647-3412
- NPI assigned
- Aug 3, 2023
- Last updated
- Aug 3, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 118555 | IA | Primary |
Addresses
Primary practice location
61 4TH St
Woodbine, IA 51579-1259
Mailing address
61 4TH St
Woodbine, IA 51579-1259
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1720 N 16TH St
Suite K
Council Bluffs, IA 51501-0109
Phone (712) 256-4420
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 118555 | IA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Connections, Inc | Current | Accepting new patients |
Locations
1720 N 16th St
Ste K
Council Bluffs, IA 51501
Phone (712) 256-4420
61 4th St
Woodbine, IA 51579
Phone (712) 256-4420
Organizations & group practices 1
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.
-
- Case Management Agency
- Council Bluffs, IA
- NPI 1740357300
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1691020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691020800000",
"number": "1972285419",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "61 4TH ST",
"city": "WOODBINE",
"state": "IA",
"postal_code": "515791259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "61 4TH ST",
"city": "WOODBINE",
"state": "IA",
"postal_code": "515791259",
"telephone_number": "712-647-3412"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FLY",
"first_name": "NICHOLAS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-08-03",
"last_updated": "2023-08-03",
"certification_date": "2023-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IA",
"license": "118555",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodbine, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 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.