Nicole A. Wizeman, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

3298 Issued in CT

Practice address

71 Haynes St
Manchester, CT 06040-4131

Phone

(860) 533-6595

Fax

(860) 533-6594

NPI assigned

Feb 23, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT, MA2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Riverbend Medical Group IncGroup PAC ID 5698064343, 227 clinicians

SC Orthopedics of New England, PC.Group PAC ID 4385907609, 10 clinicians

Orthopedic Associates of Hartford,PCGroup PAC ID 1850382409, 95 clinicians

Ortho Ma LLCGroup PAC ID 8729515507, 16 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Medical Ctr Hospital, Springfield, MA, CCN 220066

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Orthopedic Associates of Hartford,PC

  • Orthopaedic Surgery Physician
  • Hartford, CT
  • NPI 1972500304
  Medicare reassignment Care Compare group NPD (past)
• Ortho Ma LLC

  • Physician Assistant
  • Longmeadow, MA
  • NPI 1730913773
  Medicare reassignment Care Compare group
• Riverbend Medical Group, Inc.

  • Internal Medicine Physician
  • Springfield, MA
  • NPI 1841651197
  Medicare reassignment Care Compare group
• SC Orthopedics of New England,PC.

  • Orthopaedic Surgery Physician
  • Springfield, MA
  • NPI 1922502095
  Medicare reassignment Care Compare group
• Hartford Healthcare Medical Group Specialists, PLLC

  • Surgery Physician
  • Hartford, CT
  • NPI 1023584216
  Medicare reassignment
• Prospect CT Medical Foundation, Inc.

  • Family Medicine Physician
  • Manchester, CT
  • NPI 1144677568
  Medicare reassignment
• Vipul Dua, MD, LLC

  • Orthopaedic Surgery Physician
  • South Windsor, CT
  • NPI 1033548029
  Medicare reassignment
• Mercy Inpatient Medical Associates Inc.

  • Internal Medicine Physician
  • Springfield, MA
  • NPI 1407845282
  Medicare reassignment
• Orthopedic Associates of Hartford,PC

  • Durable Medical Equipment & Medical Supplies
  • Enfield, CT
  • NPI 1235922584
  NPD
• Orthopedic Associates of Hartford,PC

  • Orthopaedic Surgery Physician
  • Glastonbury, CT
  • NPI 1659488815
  NPD
• Riverbend Medical Group, Inc

  • Durable Medical Equipment & Medical Supplies
  • Springfield, MA
  • NPI 1265023154
  NPD
• Eastern Connecticut Medical Professionals Foundation Inc

  • Family Medicine Physician
  • Manchester, CT
  • NPI 1770557712
  NPD (past)

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

• The Mercy Hospital Inc

  • General Acute Care Hospital
  • Springfield, MA
  • NPI 1043204316
  Care Compare affiliation
• The Mercy Hospital Inc

  • Rehabilitation Hospital Unit
  • Springfield, MA
  • NPI 1750360798
  Care Compare affiliation

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

{
    "created_epoch": "1424649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485734400000",
    "number": "1134511595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "71 HAYNES ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060404131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71 HAYNES ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060404131",
            "telephone_number": "860-533-6595",
            "fax_number": "860-533-6594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIZEMAN",
        "first_name": "NICOLE",
        "middle_name": "A.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-23",
        "last_updated": "2017-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CT",
            "license": "3298",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MA",
            "license": "PA5251",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4686907",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Winter, DDS, MD
• Corrine Winters
• Brian Wirtalla, DPT, CSCS
• Erin O'Marra Wissler, PHARMD
• Ikea Witt
• Crystal L Woike
• Monika Wojtak
• Leslie Burleigh Wolfenden, OTR/L
• Yanira Wolfgang-Pinto, LCSW
• Kelly Wolohan

• Surgical Physician Assistant in Manchester, CT
• Providers in Manchester, CT by specialty
• Surgical Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2017; 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.