NPIMap

Individual provider Active NPI

Nicole M Chicker, APNP

  • Nurse Practitioner
  • Stoughton, WI
National Provider Identifier
1306628763
Registry record updated Dec 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
14658-33 Issued in WI
Practice address
225 Church St
Stoughton, WI 53589-1801
Phone
(608) 877-2777
Fax
(608) 877-2774
NPI assigned
Oct 19, 2023
Last updated
Dec 15, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 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 14658-33 WI Primary
Family Medicine Physician 207Q00000X 14658-33 WI

Addresses

Primary practice location

225 Church St
Stoughton, WI 53589-1801

Mailing address

225 Church St
Stoughton, WI 53589-1801
Phone (608) 877-2777

Other identifiers 1

IdentifierTypeStateIssuer
1306628763MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address nchicker259120@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
I20231220000766 WI Practitioner - Nurse Practitioner 8820448640 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dean Health Systems IncGroup PAC ID 7012827983, 1,174 clinicians

Practice addresses (Care Compare)

225 Church St
Stoughton, WI 53589-1801
Phone (608) 877-2777

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14658-33WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dean Health Systems, Inc Family Medicine CurrentSince Dec 11, 2023 Accepting new patients
Dean Health Systems, Inc. CurrentSince Dec 11, 2023 Accepting new patients

Locations

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

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

225 Church St
Stoughton, WI 53589
Phone (608) 877-2700

Organizations & group practices 2

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 8

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": "1697673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702598400000",
    "number": "1306628763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 CHURCH ST",
            "city": "STOUGHTON",
            "state": "WI",
            "postal_code": "535891801",
            "telephone_number": "608-877-2777",
            "fax_number": "608-877-2774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 CHURCH ST",
            "city": "STOUGHTON",
            "state": "WI",
            "postal_code": "535891801",
            "telephone_number": "608-877-2777",
            "fax_number": "608-877-2774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHICKER",
        "first_name": "NICOLE",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-19",
        "last_updated": "2023-12-15",
        "certification_date": "2023-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "14658-33",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "14658-33",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306628763",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nchicker259120@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "nchicker259120@direct-ehr-ssmhc.com",
            "address_1": "225 Church St",
            "city": "Stoughton",
            "state": "WI",
            "country_code": "US",
            "postal_code": "535891801",
            "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": "225 Church St",
            "city": "Stoughton",
            "state": "WI",
            "country_code": "US",
            "postal_code": "535891801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Stoughton, WI

Sources for this page

Verify at the official NPI Registry.