NPIMap

Individual provider Active NPI

Kelley Nicole Dilliard, DO

  • Family Medicine Physician
  • Wausau, WI
National Provider Identifier
1114411956
Registry record updated Sep 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
75853-21 Issued in WI
Practice address
2720 Plaza Dr Ste 1300
Wausau, WI 54401-4165
Phone
(715) 847-2630
NPI assigned
Jun 15, 2018
Last updated
Sep 1, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036153728 IL
Family Medicine Physician 207Q00000X 75853-21 WI Primary

Addresses

Primary practice location

2720 Plaza Dr Ste 1300
Wausau, WI 54401-4165

Mailing address

2720 Plaza Dr Ste 1300
Wausau, WI 54401-4165
Phone (715) 847-2630

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20210916002840 WI Practitioner - Family Practice 9830527753 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Liberty Univ College of Osteopathic Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Aspirus Wausau Hospital IncGroup PAC ID 6406757442, 242 clinicians

Practice addresses (Care Compare)

333 Pine Ridge Blvd
Wausau, WI 54401-4102
Phone (715) 847-2866

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.56 of 100Reported as group
Quality
87.43
Promoting interoperability
100
Improvement activities
40
Cost
78.24

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Aspirus Wausau Hospital, Inc. CurrentSince Sep 1, 2021 Accepting new patients
Aspirus Wausau Hospital, Inc. CurrentSince Sep 1, 2021 Accepting new patients
Aspirus Wausau Hospital, Inc. Current Accepting new patients
Aspirus Wausau Hospital, Inc. Past Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

2720 Plaza Dr
Ste 1300
Wausau, WI 54401
Phone (715) 847-2630

333 Pine Ridge Blvd
Wausau, WI 54401
Phone (715) 847-2160

Interoperability endpoints

  • Direct secure messaging: kdilliard166219@direct.aspirus.org

Organizations & group practices 4

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

Hospital & facility affiliations 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1529020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630454400000",
    "number": "1114411956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2720 PLAZA DR STE 1300",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544014165",
            "telephone_number": "715-847-2630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2720 PLAZA DR STE 1300",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544014165",
            "telephone_number": "715-847-2630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DILLIARD",
        "first_name": "KELLEY",
        "middle_name": "NICOLE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-15",
        "last_updated": "2021-09-01",
        "certification_date": "2021-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036153728",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "75853-21",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wausau, WI

Sources for this page

Verify at the official NPI Registry.