NPIMap

Individual provider Active NPI

Ross S Wickstrom, CNP

  • Family Nurse Practitioner
  • Wilmington, OH
National Provider Identifier
1003265364
Registry record updated Dec 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN.CNP.19152 Issued in OH
Practice address
1184 W Locust St
Wilmington, OH 45177-2009
Phone
(937) 382-1616
NPI assigned
Jun 8, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN.CNP.19152 OH Primary
Family Nurse Practitioner 363LF0000X COA.19152-NP OH

Addresses

Primary practice location

1184 W Locust St
Wilmington, OH 45177-2009

Mailing address

1184 W Locust St
Wilmington, OH 45177-2009
Phone (937) 382-1616

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160714001888 OH Practitioner - Nurse Practitioner 4880986645 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of North Carolina at Chapel Hill School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Trihealth G LLCGroup PAC ID 0749222651, 294 clinicians

Practice addresses (Care Compare)

1184 W Locust St
Wilmington, OH 45177-2009
Phone (937) 382-1616

2001 Anderson Ferry Rd
Cincinnati, OH 45238-3325
Phone (513) 246-7000

Hospital & facility affiliations

  • Adams County Homecare LLC Home health agency, Winchester, OH, CCN 367055
  • Bethesda North Hospital, Cincinnati, OH, CCN 360179
  • Trihealth Clinton Regional Hospital Hospital, Wilmington, OH, CCN 360175
  • Good Samaritan Hospital Hospital, Cincinnati, OH, CCN 360134
  • Highland District Hospital Hospital, Hillsboro, OH, CCN 361332

Merit-based Incentive Payment System (MIPS)

Final score
88.71 of 100Reported as group
Quality
83.07
Promoting interoperability
100
Improvement activities
40
Cost
79.29

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
COA.19152-NPOHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Trihealth G LLC CurrentSince Dec 16, 2024 Accepting new patients
Trihealth G, LLC CurrentSince Dec 16, 2024 Accepting new patients

Locations

2001 Anderson Ferry Rd
Cincinnati, OH 45238
Phone (513) 922-1200

1184 W Locust St
Wilmington, OH 45177
Phone (937) 382-1616

Interoperability endpoints

  • Direct secure messaging: rwickstrom450841@direct.trihealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1465344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734480000000",
    "number": "1003265364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1184 W LOCUST ST",
            "city": "WILMINGTON",
            "state": "OH",
            "postal_code": "451772009",
            "telephone_number": "937-382-1616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1184 W LOCUST ST",
            "city": "WILMINGTON",
            "state": "OH",
            "postal_code": "451772009",
            "telephone_number": "937-382-1616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKSTROM",
        "first_name": "ROSS",
        "middle_name": "S",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-08",
        "last_updated": "2024-12-18",
        "certification_date": "2024-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CNP.19152",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "COA.19152-NP",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, OH

Sources for this page

Verify at the official NPI Registry.