Nicole A Deller, PMHNP
Individual provider Active NPI Nurse Practitioner · Angola, IN
NPI 1114157641 · NPPES record last updated Mar 7, 2024
Key facts
- NPI
- 1114157641
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 71004983A (IN)
- Practice address
- 301 E Maumee St
Angola, IN 46703-2012 - Phone
- (260) 675-7535
- Fax
- (260) 373-8034
- NPI assigned
- Jul 17, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 9
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Indiana Medical College, School of Medicine of Purdue University, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Cameron Memorial Community Hospital Inc
Practice addresses (Care Compare)
301 E Maumee St
Angola, IN 46703-2012
Phone (260) 675-7535
Hospital & facility affiliations
- Cameron Health
Merit-based Incentive Payment System (MIPS)
- Final score
- 83.53 of 100
- Quality
- 70
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 75.11
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.78 of 100
- Quality
- 80.38
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- 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 |
|---|---|---|---|---|
| I20141107000541 | IN | Practitioner - Nurse Practitioner | 5193947141 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN9239834 | FL | MD | Registered Nurse |
| 71004983A | IN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cameron Memorial Community Hospital, Inc | Current |
Accepting new patients | |
| Cameron Memorial Community Hospital, Inc. | Current |
Accepting new patients | |
| Aberdeen Group LLC | Past | Accepting new patients |
Locations
301 E Maumee St
Angola, IN 46703
Phone (260) 665-2164
306 E Maumee St
Angola, IN 46703
Phone (260) 667-5335
416 E Maumee St
Angola, IN 46703
Phone (260) 665-2141
Interoperability endpoints
- ndeller79475@direct.parkviewexchange.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN9239834 | FL | |
| Nurse Practitioner | 363L00000X | 71004983A | IN | Yes |
Addresses
Primary practice location
301 E Maumee St
Angola, IN 46703-2012
Mailing address
416 E Maumee St
Angola, IN 46703-2015
Other providers in Angola, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2024. 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.