BENJAMIN ANTHONY NICOTERA MD
NPI 1407353790
Student in an Organized Health Care Education/Training Program in O Fallon, IL

Q: What is Benjamin Nicotera's NPI number?

The NPI number for Benjamin Nicotera is 1407353790. It was assigned to this individual provider in the NPPES registry on April 12, 2018.

Q: What is Benjamin Nicotera's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Benjamin Nicotera was last updated on April 12, 2018. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since April 12, 2018PECOS Enrolled

3 SAINT ELIZABETH BLVD STE 4000, O FALLON, IL 62269(618) 233-5480(618) 222-4792 Get Directions Write a Review

NPPES record last updated: April 12, 2018. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Benjamin Anthony Nicotera Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BENJAMIN ANTHONY NICOTERA MD (NPI 1407353790) is an individual student in an organized health care education/training program in O Fallon, Illinois and active in the NPI registry since April 2018. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1407353790

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameBENJAMIN ANTHONY NICOTERACredential: MD

Location Address3 SAINT ELIZABETH BLVD STE 4000O Fallon, IL 62269-1284

Mailing Address395 State St, Right SideAmherst, MA 01002 · (413) 244-2936

Phone(618) 233-5480

Fax(618) 222-4792

Sole ProprietorNo

Enumeration DateApril 12, 2018

✔ NPI 1407353790 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

3 SAINT ELIZABETH BLVD STE 4000, O Fallon, IL 62269

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Benjamin Anthony Nicotera Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MARA GRACE DOWNING MD

Student in an Organized Health Care Education/Training Program