DAVID J NICHOLSON, D.O. - NPI NUMBER 1083779466

Summary

Provider Name: DAVID J NICHOLSON, D.O.

NPI Number: 1083779466

Clasification: Internal Medicine (207R00000X)

Organization: OHIOHEALTH CORPORATION

Address:
765 N HAMILTON RD
GAHANNA, OH
ZIP 43230

Phone Number: (614) 533-5000



Detailed Information

David J Nicholson, D.O. is an internist in Gahanna, OH with 11 years of experience. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. The assigned NPI number for this provider is 1083779466 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: OHIO UNIVERSITY OF OSTEO MEDICINE
Graduation Year: 2004

The provider's business address is:

765 N HAMILTON RD
GAHANNA, OH
ZIP 43230-703
Phone: (614) 533-5000
Fax: (614) 533-5059

The enumeration date for this NPI number is 12/26/2006 and was last updated on 12/16/2013.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207R00000X Internal Medicine 34008840 OH No
2 207RC0000X Internal Medicine Cardiovascular Disease 34.008840 OH Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 2729908 MEDICAID OH
2 H014130 MEDICARE PIN OH

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1083779466 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 1 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Provider Last Name Legal Name NICHOLSON The last name of the provider. If the provider is an individual, this is the legal name.
4 Provider First Name DAVID The first name of the provider, if the provider is an individual.
5 Provider Middle Name J The middle name of the provider, if the provider is an individual.
6 Provider Credential Text D.O. The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
7 Provider First Line Business Practice Location Address 765 N HAMILTON RD The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Business Practice Location Address City Name GAHANNA The city name in the location address of the provider being identified.
9 Provider Business Practice Location Address State Name OH The State code in the location of the provider being identified.
10 Provider Business Practice Location Address Postal Code 432308703 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
11 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
12 Provider Business Practice Location Address Telephone Number 6145335000 The telephone number associated with the location address of the provider being identified.
13 Provider Business Practice Location Address Fax Number 6145335059 The fax number associated with the location address of the provider being identified.
14 Provider Enumeration Date 12/26/2006 The date the provider was assigned a unique identifier (assigned an NPI).
15 Last Update Date 12/16/2013 The date that a record was last updated or changed.
16 Provider Gender Code M The code designating the provider’s gender if the provider is a person.
17 Healthcare Provider Taxonomy Code 1 207R00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
18 Provider License Number 1 34008840 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
19 Provider License Number State Code 1 OH The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
20 Healthcare Provider Primary Taxonomy Switch 1 N
21 Healthcare Provider Taxonomy Code 2 207RC0000X
22 Provider License Number 2 34.008840 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
23 Provider License Number State Code 2 OH The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
24 Healthcare Provider Primary Taxonomy Switch 2 Y
25 Other Provider Identifier 1 2729908 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
26 Other Provider Identifier Type Code 1 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
27 Other Provider Identifier State 1 OH
28 Other Provider Identifier 2 H014130 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
29 Other Provider Identifier Type Code 2 08 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
30 Other Provider Identifier State 2 OH
31 Is Sole Proprietor N Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No

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This page was last updated on: 4/19/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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