Shandell Lee Herrick, FNP-BC

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

246761-30 Issued in WI

Practice address

125 Hospital Dr
Watertown, WI 53098-3303

Phone

(262) 325-9309

NPI assigned

Mar 7, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Watertown Physician Practices LLCGroup PAC ID 8022329408, 64 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Watertown Memorial Hospital Hospital, Watertown, WI, CCN 520116
• Fort Memorial Hospital Hospital, Fort Atkinson, WI, CCN 520071

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shandell.herrick.1@17022.direct.athenahealth.com

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.

• Watertown Physician Practices LLC

  • Family Medicine Physician
  • Watertown, WI
  • NPI 1770964363
  Medicare reassignment Care Compare group NPD
• Watertown Physician Practices LLC

  • Obstetrics & Gynecology Physician
  • Watertown, WI
  • NPI 1225412265
  NPD

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

• Fort Healthcare Inc

  • Otolaryngology Physician
  • Fort Atkinson, WI
  • NPI 1417993361

  Hospital

  Care Compare affiliation
• Fort Healthcare, Inc.

  • General Acute Care Hospital
  • Fort Atkinson, WI
  • NPI 1811916281
  Care Compare affiliation
• Watertown Medical Center LLC

  • General Acute Care Hospital
  • Watertown, WI
  • NPI 1992776041
  Care Compare affiliation

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

{
    "created_epoch": "1709769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709769600000",
    "number": "1003674896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 MARY KNOLL LN",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530981219",
            "telephone_number": "262-325-9309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 HOSPITAL DR",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530983303",
            "telephone_number": "262-325-9309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERRICK",
        "first_name": "SHANDELL",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-03-07",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "246761-30",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hearing Center, Inc.
• Melanie Terese Heese, RN
• Robert Delano Heinen, MD
• Amber Rose Hendriksen, NP
• Heritage Assisted Living of Watertown, LLC
• Desiree Monik Herron, O.D.
• Gwen Herzog, RN
• Catherine Hetzel
• Angela Hill, OTR
• Nicholas Earl Hoening, PT

• Registered Nurse in Watertown, WI
• Providers in Watertown, WI by specialty
• Registered Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.