NICOLE MARIE POTHAST (MSN, CNM) – Advanced Practice Midwife, NPI 1104376219

NICOLE MARIE POTHAST (MSN, CNM) is a healthcare provider. based in Bryan, Ohio. specializing in CERTIFIED NURSE MIDWIFE (CNM). They hold the professional credentials MSN, CNM. They hold a License No. 71006654 (IN). The NPI Number for NICOLE MARIE POTHAST (MSN, CNM) is 1104376219

Main info

Female
10 Years Of Experience
Accepts Medicare Assignment
Name
NICOLE MARIE POTHAST (MSN, CNM)
NPI
1104376219
Phone
(419) 636-5414
Address
433 W HIGH ST
Enumeration Date
12 October 2016
Last Update Date
8 April 2020

Doctor Profile

Medical School Name
OTHER
Secondary Phone
4194240180
Graduation Year
2016 (10 years ago)
PAC ID
3072891670
Group Practice PAC ID
9234168147
Professional Enrollment ID
I20170815003258
Address ID
OH458401241FI301XXSTXX400
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience51
Completeness75
Years active:9State licenses:2Digital endpointsOther names

292 CERTIFIED NURSE MIDWIFE (CNM) in OH

Provider Addresses for NICOLE MARIE POTHAST (MSN, CNM)

  • 433 W HIGH ST

    BRYAN, OH 435061690

    Phone: (419) 636-5414

    Fax: (419) 636-3100

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2017-08-15

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20170815003258ICertified Nurse Midwife (Cnm)OHTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 43506)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 9234168147View full group profile
NameSpecialtyState
Nurse PractitionerOH
-OH
Nurse PractitionerOH
-OH
Physician AssistantPA
Nurse PractitionerOH
Nurse PractitionerOH
Family PracticeIN
Nurse PractitionerOH
Pediatric MedicineOH

Reviews

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Frequently asked questions

Is NICOLE MARIE POTHAST (MSN, CNM) listed with a National Provider Identifier?
Yes — NICOLE MARIE POTHAST (MSN, CNM) has NPI 1104376219 on file in the registry.
Is there an active status for NICOLE MARIE POTHAST (MSN, CNM)?
For scheduling context, NICOLE MARIE POTHAST (MSN, CNM) is shown as active in the registry.
How would a patient describe NICOLE MARIE POTHAST (MSN, CNM)'s focus?
For NICOLE MARIE POTHAST (MSN, CNM), the primary taxonomy reads as Advanced Practice Midwife. Clinical services aligned with this taxonomy classification.
Where in Ohio is NICOLE MARIE POTHAST (MSN, CNM) registered?
Use Bryan, Ohio as the headline location for NICOLE MARIE POTHAST (MSN, CNM) here.
Does NICOLE MARIE POTHAST (MSN, CNM) accept insurance?
Insurance participation is not part of the core NPI extract — call the plan or office to confirm.

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