NPIMap

Individual provider Active NPI

Nichole Decorah, LPC-IT

  • Professional Counselor
  • Portage, WI
National Provider Identifier
1154894848
Registry record updated Aug 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
5176-226 Issued in WI
Practice address
1508 New Pinery Rd
Portage, WI 53901-1312
Phone
(608) 745-4900
NPI assigned
Jan 6, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 21, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 5176-226 WI Primary

Addresses

Primary practice location

1508 New Pinery Rd
Portage, WI 53901-1312

Mailing address

532 Laurel St
Reedsburg, WI 53959-1231
Phone (608) 566-5187

Other practice location 1

752 N High Point Rd
Madison, WI 53717-2236
Phone (608) 824-4000

Other identifiers 1

IdentifierTypeStateIssuer
1154894848MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address ndecorah517775@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

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
I20240828001602 WI Practitioner - Mental Health Counselor 1456890912 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dean Health Systems Inc 1,174 clinicians

Practice addresses (Care Compare)

752 N High Point Rd
Madison, WI 53717-2236
Phone (608) 824-4000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5176-226WIMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Compass Counseling, LLC CurrentSince Nov 28, 2021 Accepting new patients
Dean Health Systems, Inc CurrentSince Aug 14, 2024 Accepting new patients
Dean Health Systems, Inc. CurrentSince Aug 14, 2024 Accepting new patients
Lutheran Social Services of Wisconsin and Upper Michigan, Inc. PastSince Aug 1, 2021 Accepting new patients

Locations

752 N High Point Rd
Madison, WI 53717
Phone (608) 824-4000

1808 W Beltline Hwy
Madison, WI 53713
Phone (608) 250-1497

515 22nd Ave
Monroe, WI 53566
Phone (608) 324-1000

1508 New Pinery Rd
Portage, WI 53901
Phone (608) 742-4533

Organizations & group practices 24

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.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1546732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724198400000",
    "number": "1154894848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "532 LAUREL ST",
            "city": "REEDSBURG",
            "state": "WI",
            "postal_code": "539591231",
            "telephone_number": "608-566-5187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1508 NEW PINERY RD",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539011312",
            "telephone_number": "608-745-4900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "752 N High Point Rd",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "WI",
            "postal_code": "537172236",
            "country_code": "US",
            "telephone_number": "608-824-4000",
            "fax_number": "608-824-4938",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DECORAH",
        "first_name": "NICHOLE",
        "credential": "LPC-IT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-06",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "5176-226",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1154894848",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ndecorah517775@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "ndecorah517775@direct-ehr-ssmhc.com",
            "address_1": "752 N High Point Rd",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537172236",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "752 N High Point Rd",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537172236",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portage, WI

Sources for this page

Verify at the official NPI Registry.