Nicole Wagner, APN

Primary specialty

Adult Health Clinical Nurse SpecialistTaxonomy code 364SA2200X

License

209004749 Issued in IL

Practice address

431 W Liberty St
Wauconda, IL 60084-2452

Phone

(847) 526-2151

Fax

(847) 526-2017

NPI assigned

Apr 14, 2009

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

Medicare fee-for-service enrollment

Enrolled in IL

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 1

Specialty

Certified Clinical Nurse Specialist (CNS)

Education

Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Family Medicine Specialists of Round Lake Incorporated S CGroup PAC ID 6002957511, 20 clinicians

Family Medicine Specialists S.C.Group PAC ID 0042206252, 24 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Family Medicine Specialists of Round Lake Incorporated S C

  • Family Medicine Physician
  • Round Lake Beach, IL
  • NPI 1740515253
  Medicare reassignment Care Compare group NPD
• Family Medicine Specialists, S.C.

  • Family Medicine Physician
  • Wauconda, IL
  • NPI 1063406601
  Medicare reassignment Care Compare group NPD
• All Time Urgent and Medical Care LTD

  • Internal Medicine Physician
  • Libertyville, IL
  • NPI 1609536887
  Medicare reassignment NPD
• Family Medicine Specialists of Mount Prospect S C

  • Family Medicine Physician
  • Mt Prospect, IL
  • NPI 1437389475
  Medicare reassignment NPD
• William C. Dam, M.D.S.C.

  • Internal Medicine Physician
  • Ingleside, IL
  • NPI 1760632459
  NPD

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

{
    "created_epoch": "1239667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561334400000",
    "number": "1194968602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6037",
            "city": "WAUCONDA",
            "state": "IL",
            "postal_code": "60084",
            "telephone_number": "847-526-2151",
            "fax_number": "847-526-2017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "431 W LIBERTY ST",
            "city": "WAUCONDA",
            "state": "IL",
            "postal_code": "600842452",
            "telephone_number": "847-526-2151",
            "fax_number": "847-526-2017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "NICOLE",
        "name_prefix": "Ms.",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-14",
        "last_updated": "2019-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209004749",
            "primary": false
        },
        {
            "code": "364SA2200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Adult Health",
            "state": "IL",
            "license": "209004749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie K Vance, DPT
• Elizabeth Lynn Vanvleet, LCSW
• Richard John Abais Villaceran
• Karen Anne Fermin Violago, NP-C
• Jana Wagner, MS
• Walgreen Co
• Walgreens Boots Alliance
• Wauconda Cusd 118
• Wauconda Fire Department
• Wauconda Fire Protection District

• Adult Health Clinical Nurse Specialist in Wauconda, IL
• Providers in Wauconda, IL by specialty
• Adult Health Clinical Nurse Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2019; 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.