Individual provider Active NPI

Nicole Philippon, NP

  • Nurse Practitioner
  • Monroe, MI
National Provider Identifier
1255957494
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704315954 Issued in MI
Practice address
718 N Macomb St
Monroe, MI 48162-7815
Phone
(734) 240-8835
NPI assigned
Jun 23, 2020
Last updated
Nov 3, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4704315954 MI Primary
Acute Care Nurse Practitioner 363LA2100X 4704315954 MI

Addresses

Primary practice location

718 N Macomb St
Monroe, MI 48162-7815

Mailing address

740 Saint Anne LN
Monroe, MI 48162-3548
Phone (419) 344-9970

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address nphilippon95449@epicdirect.promedica.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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

Enrollment IDStateProvider typePAC IDDetails
I20201026001869 MI Practitioner - Nurse Practitioner 9931529260 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

730 N Macomb St
Suite 228
Monroe, MI 48162-3087
Phone (734) 242-7060

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704315954MIMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Monroe Physicians CurrentSince Nov 1, 2020 Accepting new patients
Promedica Northwest Ohio Cardiology Consultants, LLC CurrentSince Mar 11, 2024 Accepting new patients
Promedica Northwest Ohio Cardiology Consultants CurrentSince Mar 11, 2024 Accepting new patients

Locations

770 Riverside Ave
Ste 106
Adrian, MI 49221
Phone (517) 266-0525

3175 Smith Rd
Lambertville, MI 48144
Phone (734) 856-5494

718 N Macomb St
Monroe, MI 48162
Phone (734) 212-3097

730 N Macomb St
Ste 228
Monroe, MI 48162
Phone (734) 242-7060

100 Madison Ave
Toledo, OH 43604
Phone (567) 585-1964

Organizations & group practices 3

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 2

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

NPI Registry JSON

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

{
    "created_epoch": "1592870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1255957494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "740 SAINT ANNE LN",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481623548",
            "telephone_number": "419-344-9970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "718 N MACOMB ST",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481627815",
            "telephone_number": "734-240-8835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILIPPON",
        "first_name": "NICOLE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-23",
        "last_updated": "2023-11-03",
        "certification_date": "2020-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704315954",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MI",
            "license": "4704315954",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nphilippon95449@epicdirect.promedica.org",
            "affiliation": "N",
            "address_1": "100 Madison Ave",
            "city": "Toledo",
            "state": "OH",
            "country_code": "US",
            "postal_code": "436041516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Monroe, MI

Sources for this page

Verify at the official NPI Registry.