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MICHAEL J PEGRAM CNP
NPI 1851725170
Nurse Practitioner in Cincinnati, OH

Active since August 22, 2013PECOS EnrolledAccepts Medicare Assignment
78.78/100
CMS Quality Rating
222 PIEDMONT AVE, CINCINNATI, OH 45219(513) 475-7505(513) 475-7355 Get Directions Write a Review

NPPES record last updated: January 5, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jan 5, 2024, Aug 17, 2022 (2 updates tracked since 2022).

About Michael J Pegram Cnp NPPES

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

MICHAEL J PEGRAM CNP (NPI 1851725170) is an individual nurse practitioner in Cincinnati, Ohio, licensed in Ohio (APRN.CNP.14769) and active in the NPI registry since August 2013. He is enrolled in Medicare PECOS, is affiliated with University Of Cincinnati Medical Center, Llc, and is a graduate of University Of Cincinnati College Of Medicine (2013).

NPPES Registry Identity

NPI1851725170
Entity TypeIndividualMale
Primary Taxonomy363L00000X
Provider Legal NameMICHAEL J PEGRAMCredential: CNP
Location Address222 PIEDMONT AVECincinnati, OH 45219-4231
Mailing Address222 Piedmont AveCincinnati, OH 45219-4231 · (513) 475-7505 · Fax (513) 475-7355
Phone(513) 475-7505
Fax(513) 475-7355
Sole ProprietorNo
Medical School CMSUniversity Of Cincinnati College Of MedicineGraduated 2013
Enumeration DateAugust 22, 2013
Last NPPES UpdateJanuary 5, 20242 updates tracked since enumeration
NPPES CertifiedJanuary 5, 2024
✔ NPI 1851725170 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License✔ Licensed in OH · APRN.CNP.14769
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
222 PIEDMONT AVE, Cincinnati, OH 45219
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, CareSource, MedMutual and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Michael J Pegram Cnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3274768999
PECOS Enrollment IDI20131104001577
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.

Medicare Billing Reassignments

2

Medicare enrollment records show Michael Pegram reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

University Of Cincinnati Physicians Company, LLC
0.1 mi
Family Medicine
3188 BELLEVUE AVE
Cincinnati, OH 45219
  • Reassigned Medicare billing, Ohio enrollment
  • 2,038 clinicians in this Medicare group
NPI 1801840434 (513) 584-1000
Qualified Emergency Specialists Inc
12 mi
Emergency Medicine
10500 MONTGOMERY RD
Montgomery, OH 45242
  • Reassigned Medicare billing, Ohio enrollment
  • 119 clinicians in this Medicare group
NPI 1700872728 (513) 865-1307

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 7

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
103 services81 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
48 services44 patients
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
38 services38 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
24 services24 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
22 services18 patients
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
12 services12 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

University Of Cincinnati Medical Center, LLC

Acute Care Hospitals · Cincinnati, OH
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number360003
Location3188 Bellevue AvenueCincinnati, OH 45219 · Hamilton County
Emergency services Birthing friendly

West Chester Hospital

Acute Care Hospitals · West Chester, OH
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number360354
Location7700 University DriveWest Chester, OH 45069 · Butler County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 45219 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$84.72 typical visit price
range $54.34 – $166.65
Typical copayment $21.18 (range $13.58 – $41.66)
Most-billed visit code 99203
Established Patient
$96.44 typical visit price
range $17.10 – $135.40
Typical copayment $24.11 (range $4.27 – $33.85)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

78.78/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality70.42
Promoting Interoperability100
Improvement Activities40
Cost58.86

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.

BERNICE K KLABEN PH.D.-CCC-SLP-BRS-S
Speech-Language Pathologist
222 PIEDMONT AVE
CINCINNATI, OH 45219
Hamilton County (513) 475-8400
BARBARA RUTH CUNNINGHAM RN
Allergy & Immunology (Clinical & Laboratory Immunology)
222 PIEDMONT AVE, SUITE 5200
CINCINNATI, OH 45219
Hamilton County (513) 475-8400
MRS. CHERYL DOREEN HERRLE CNP
Nurse Practitioner (Gerontology)
222 PIEDMONT AVE
CINCINNATI, OH 45219
Hamilton County (513) 475-7400
REBECCA HARDT CNP
Nurse Practitioner (Adult Health)
222 PIEDMONT AVE
CINCINNATI, OH 45219
Hamilton County (513) 475-7505
MRS. RONDA BAUER
Licensed Practical Nurse
222 PIEDMONT AVE, SUITE 5200
CINCINNATI, OH 45219
Hamilton County (513) 475-7363
CARRIE LYNN JENNINGS CNP
Nurse Practitioner (Family)
222 PIEDMONT AVE
CINCINNATI, OH 45219
Hamilton County (513) 475-7505
ALBERTO ESPAY MD
Psychiatry & Neurology (Neurology)
222 PIEDMONT AVE, SUITE 3200
CINCINNATI, OH 45219
Hamilton County (513) 475-8730
GREGORY WAYNE ROUAN M.D.
Internal Medicine
222 PIEDMONT AVE, STE 6000
CINCINNATI, OH 45219
Hamilton County (513) 475-7880

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Michael Pegram's NPI number?

The NPI number for Michael Pegram is 1851725170. It was assigned to this individual provider in the NPPES registry on August 22, 2013.

Where is Michael Pegram located?

Michael Pegram practices at 222 Piedmont Ave, Cincinnati, OH 45219. The listed phone number is (513) 475-7505.

What is Michael Pegram's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Michael Pegram enrolled in Medicare?

Yes. Michael Pegram is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Michael Pegram's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Michael Pegram reassigns Medicare benefits to 2 organizations: University Of Cincinnati Physicians Company, LLC (Cincinnati, OH) and Qualified Emergency Specialists Inc (Montgomery, OH). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Michael Pegram's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Michael Pegram accept?

Health plans from Anthem Blue Cross and Blue Shield, CareSource, MedMutual, Molina Healthcare and Oscar Health Insurance list Michael Pegram as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Michael Pegram affiliated with any hospitals?

According to CMS data, Michael Pegram is affiliated with University Of Cincinnati Medical Center, LLC and West Chester Hospital.

When was this NPI record last updated?

The NPPES record for Michael Pegram was last updated on January 5, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.