NPIMap

Individual provider Active NPI

Jacquelyn D Nichols, PA-C

  • Physician Assistant
  • Stevens Point, WI
National Provider Identifier
1225570633
Registry record updated Nov 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085006030 Issued in IL
Practice address
824 Illinois Ave
Stevens Point, WI 54481-3112
Phone
(715) 342-7500
NPI assigned
Nov 16, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085006030 IL Primary

Addresses

Primary practice location

824 Illinois Ave
Stevens Point, WI 54481-3112

Mailing address

824 Illinois Ave
Stevens Point, WI 54481-3112
Phone (715) 342-7500

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
I20191107002949 WI Practitioner - Physician Assistant 5991072282 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

824 Illinois Ave
Stevens Point, WI 54481-3112
Phone (715) 344-1600

Hospital & facility affiliations

  • Aspirus Wausau Hospital Hospital, Wausau, WI, CCN 520030
  • Aspirus Stevens Point Hospital & Clinics, Inc. Hospital, Stevens Point, WI, CCN 520002
  • Aspirus Rhinelander Hospital Hospital, Rhinelander, WI, CCN 520019

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085006030ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Aspirus Rhinelander & Tomahawk Hospitals & Clinics, Inc. CurrentSince Dec 1, 2021 Accepting new patients
Aspirus Rhinelander & Tomahawk Hospitals & Clinics, Inc. CurrentSince Dec 1, 2021 Accepting new patients
Aspirus Stevens Point Hospital & Clinics, Inc. CurrentSince Oct 29, 2019 Accepting new patients
Northern Indiana Dermatology and Skin Surgery Center Past Accepting new patients
Physicians Dermpath Laboratory Past Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

2251 N Shore Dr
Ste 100
Rhinelander, WI 54501
Phone (715) 361-2074

900 Illinois Ave
Stevens Point, WI 54481
Phone (715) 342-7500

824 Illinois Ave
Stevens Point, WI 54481
Phone (715) 342-7500

Interoperability endpoints

  • Direct secure messaging: jnichols169702@direct.aspirus.org

Organizations & group practices 6

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.

Hospital & facility affiliations 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1479254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573603200000",
    "number": "1225570633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 ILLINOIS AVE",
            "city": "STEVENS POINT",
            "state": "WI",
            "postal_code": "544813112",
            "telephone_number": "715-342-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 ILLINOIS AVE",
            "city": "STEVENS POINT",
            "state": "WI",
            "postal_code": "544813112",
            "telephone_number": "715-342-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "JACQUELYN",
        "middle_name": "D",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-16",
        "last_updated": "2019-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085006030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stevens Point, WI

Sources for this page

Verify at the official NPI Registry.