Nicole Brandi Pedtke, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209021411 Issued in IL

Practice address

5680 Indian Trail Rd
Ashley, IL 62808-2527

Phone

(618) 713-3811

NPI assigned

Jun 17, 2020

Last updated

Jun 23, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

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

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Physician Services Corporation of Southern Illinois IncGroup PAC ID 9234022567, 120 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• SSM Health at Home Health-Illinois Home health agency, Mount Vernon, IL, CCN 147088
• Mederi Caretenders of Fairview Heights Home health agency, Fairview Heights, IL, CCN 147289
• SSM Health St Mary's Hospital -Centralia Hospital, Centralia, IL, CCN 140034
• Washington County Hospital Hospital, Nashville, IL, CCN 141308
• Good Samaritan Regional HLTH Center Hospital, Mount Vernon, IL, CCN 140046

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: npedtke80457@direct-ehr-ssmhc.com

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.

• Physician Services Corporation of Southern Illinois Inc.

  dba SSM Health Medical Group

  • Internal Medicine Physician
  • Mount Vernon, IL
  • NPI 1831101807
  Medicare reassignment Care Compare group NPD
• St. Mary's Hospital, Centralia, Illinois

  dba SSM Health St. Mary's Hospital - Centralia

  • Emergency Medicine Physician
  • Centralia, IL
  • NPI 1770687196
  Medicare reassignment NPD
• St. Mary's Hospital, Centralia, Illinois

  dba SSM Health St. Mary's Hospital - Centralia

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Centralia, IL
  • NPI 1710105192
  NPD

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

• Caretenders Visiting Services of Southern Illinois, LLC

  dba Mederi Caretenders

  • Home Health Agency
  • Fairview Heights, IL
  • NPI 1770652919
  Care Compare affiliation
• Good Samaritan Regional Health Center

  dba SSM Health Good Samaritan Hospital - Mt. Vernon

  • General Acute Care Hospital
  • Mount Vernon, IL
  • NPI 1609897339
  Care Compare affiliation
• SSM Health Businesses

  dba SSM Health at Home Home Health Glen Carbon

  • Home Health Agency
  • Mount Vernon, IL
  • NPI 1295798403
  Care Compare affiliation
• St Mary's Hospital, Centralia, Illinois

  dba SSM Health St. Mary's Hospital - Centralia

  • General Acute Care Hospital
  • Centralia, IL
  • NPI 1083617245
  Care Compare affiliation
• Washington County Hospital District

  dba Washington County Hospital Walk In Clinic

  • Rural Health Clinic/Center
  • Nashville, IL
  • NPI 1316555816

  Hospital

  Care Compare affiliation
• Washington County Hospital District

  dba Washington County Hospital

  • Critical Access Hospital
  • Nashville, IL
  • NPI 1659321560
  Care Compare affiliation

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

{
    "created_epoch": "1592352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592870400000",
    "number": "1326664111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5680 INDIAN TRAIL RD",
            "city": "ASHLEY",
            "state": "IL",
            "postal_code": "628082527",
            "telephone_number": "618-713-3811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5680 INDIAN TRAIL RD",
            "city": "ASHLEY",
            "state": "IL",
            "postal_code": "628082527",
            "telephone_number": "618-713-3811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDTKE",
        "first_name": "NICOLE",
        "middle_name": "BRANDI",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-17",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209021411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Makenzie Nicole Allen
• Ashley CC SCH Dist 15
• Alexia Nicole Cano
• Bruce Willis Mattmiller Jr., MHP
• Jessica Shewmake, PTA
• Courtney Shae Stern
• Wilison Family Chiropractics, LTD
• Judith Diane Wilson, DC

• Family Nurse Practitioner in Ashley, IL
• Providers in Ashley, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2020; 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.