Nicole J Charles, PAC
Individual provider Active NPI Medical Physician Assistant · Waconia, MN
NPI 1104008093 · NPPES record last updated Mar 23, 2021
Key facts
- NPI
- 1104008093
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 1081 (MN)
- Practice address
- 500 S Maple St
Waconia, MN 55387-1752 - Phone
- (952) 442-2191
- Fax
- (952) 974-3201
- NPI assigned
- Dec 3, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 10
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Ridgeview Medical Center
Practice addresses (Care Compare)
500 S Maple St
Waconia, MN 55387-1752
Phone (952) 442-2191
601 W Chandler St
Arlington, MN 55307-2127
Phone (507) 964-2271
621 S 4TH St
Le Sueur, MN 56058-2203
Phone (507) 665-3375
7907 Powers Blvd
Chanhassen, MN 55317-9502
Phone (952) 934-0570
Hospital & facility affiliations
- Ridgeview Medical Center
- Minnesota Valley Health Center Inc
- Ridgeview Sibley Medical Center
- Ridgeview Sibley Medical Center
- Minnesota Valley Health Center Inc
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080119000009 | MN | Practitioner - Physician Assistant | 0749361434 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sibley Medical Center | Current |
Accepting new patients | |
| Ridgeview Medical Center | Current |
Accepting new patients | |
| Ridgeview Medical Center | Current |
Accepting new patients | |
| Minnesota Valley Health Center Inc | Current |
Accepting new patients | |
| Minnesota Valley Health Center Inc | Current | Accepting new patients | |
| Ridgeview Medical Center | Past | Accepting new patients |
Locations
601 W Chandler St
Arlington, MN 55307
Phone (507) 964-2271
7907 Powers Blvd
Chanhassen, MN 55317
Phone (952) 934-0570
111 Hundertmark Rd
Ste 120
Chaska, MN 55318
Phone (952) 856-4001
1805 Hennepin Ave N
Glencoe, MN 55336
Phone (320) 864-3121
621 S 4th St
Le Sueur, MN 56058
Phone (507) 665-3375
4695 Shoreline Dr
Spring Park, MN 55384
Phone (952) 442-7890
560 S Maple St
Ste 220
Waconia, MN 55387
Phone (952) 442-8011
500 S Maple St
Waconia, MN 55387
Phone (612) 442-2191
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 1081 | MN | Yes |
Addresses
Primary practice location
500 S Maple St
Waconia, MN 55387-1752
Mailing address
4729 County Road 101
Minnetonka, MN 55345-2634
Phone (952) 974-3200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1081 | Other | MN | MN REGISTRATION |
Other providers in Waconia, MN
- Brittany Rose Carstens
- Carver County
- Sarah Case
- Lisa Chapman
- Baylee Chappell
- Allison Cheesebrow
- Alene Chelman
- Stephanie Krejcarek Childs
- Erin Luann Chinnock
- Jeffrey Chrest
All providers in Waconia, MN · Medical Physician Assistant in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 23, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.