NICOLE M FORNALSKI PSYD
NPI 1942909817
Clinical Neuropsychologist in Columbus, OH

Q: What is Nicole Fornalski's NPI number?

The NPI number for Nicole Fornalski is 1942909817. It was assigned to this individual provider in the NPPES registry on February 28, 2023.

Q: What is Nicole Fornalski's specialty?

The primary specialty registered for this NPI is Clinical Neuropsychologist with taxonomy code 103G00000X.

Q: When was this NPI record last updated?

The NPPES record for Nicole Fornalski was last updated on May 16, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.

Active since February 28, 2023PECOS EnrolledAccepts Medicare Assignment

480 MEDICAL CENTER DR, COLUMBUS, OH 43210(614) 293-7604(614) 293-3809 Get Directions Write a Review

NPPES record last updated: May 16, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 16, 2023, Feb 28, 2023 (2 updates tracked since 2023).

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About Nicole M Fornalski Psyd NPPES

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

NICOLE M FORNALSKI PSYD (NPI 1942909817) is an individual clinical neuropsychologist in Columbus, Ohio, licensed in Ohio (P.08416) and active in the NPI registry since February 2023. She is enrolled in Medicare PECOS, is affiliated with Ohio State University State Health System, and is a graduate of Other (2021).

NPPES Registry Identity

NPI1942909817

Entity TypeIndividualFemale

Primary Taxonomy103G00000X

Provider Legal NameNICOLE M FORNALSKICredential: PSYD

Location Address480 MEDICAL CENTER DRColumbus, OH 43210-1229

Mailing Address700 Ackerman Rd Ste 2120Columbus, OH 43202-1559 · (614) 293-7604 · Fax (614) 293-3809

Phone(614) 293-7604

Fax(614) 293-3809

Sole ProprietorNo

Medical School CMSOtherGraduated 2021

Enumeration DateFebruary 28, 2023

Last NPPES UpdateMay 16, 20232 updates tracked since enumeration

NPPES CertifiedMay 16, 2023

✔ NPI 1942909817 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinical NeuropsychologistBehavioral Health & Social Service Providers

Taxonomy Code103G00000X

License✔ Licensed in OH · P.08416

Definition

A clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing the understanding of brain-behavior relationships and the application of such knowledge to human problems.

Also ListedPsychologist · RehabilitationTaxonomy 103TR0400X · License P.08416 (OH)

480 MEDICAL CENTER DR, Columbus, OH 43210

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Other Identifiers 1

Medicaid0015860OH

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Nicole M Fornalski Psyd 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 ID345605499

PECOS Enrollment IDI20230425002869

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.

Areas of Expertise CMS Part B claims

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.

Psychotherapy, 1 hour 90837

Psychotherapy is a therapeutic interaction or treatment between a trained professional and a patient. In a 1-hour session, you'll talk about your feelings, thoughts, and behaviors to help identify and manage mental health issues. This process aids in personal growth, healing, and improved well-being.

66 services16 patients

Hospital Affiliations CMS Care Compare

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

Ohio State University State Health System

Acute Care Hospitals · Columbus, OH

4/5 CMS rating

OwnershipGovernment - State

CMS Certification Number360085

Location410 West 10th AvenueColumbus, OH 43210 · Franklin County

Emergency services Birthing friendly

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.

OSU PHYSICAL MEDICINE AND REHABILITATION, LLC

Physical Medicine & Rehabilitation

480 MEDICAL CENTER DR, 1018 DODD HALL
COLUMBUS, OH 43210

Franklin County (614) 293-4734

DR. KATLIN ROSE SCHULTZ PSYD

Psychologist (Rehabilitation)