Individual provider Active NPI

Nicole Georgann Viccari, MD

  • Diagnostic Radiology Physician
  • Mequon, WI
National Provider Identifier
1346224839
Registry record updated Nov 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
70321 Issued in WI
Practice address
10945 N Port Washington Rd Ste 201
Mequon, WI 53092-5078
Phone
(262) 292-3151
Fax
(414) 434-0467
NPI assigned
Nov 30, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 70321 WI Primary

Addresses

Primary practice location

10945 N Port Washington Rd Ste 201
Mequon, WI 53092-5078

Mailing address

10945 N Port Washington Rd Ste 201
Mequon, WI 53092-5078
Phone (262) 292-3151

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, WI, IL3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20170125000674 TX Practitioner - Diagnostic Radiology 8628218476 Reassigns benefits to 1 organization
I20190104001782 WI Practitioner - Diagnostic Radiology 8628218476 Reassigns benefits to 4 organizations
I20240304000032 IL Practitioner - Diagnostic Radiology 8628218476 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Loma Linda University School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Premier Radiology Wisconsin LLCGroup PAC ID 9537595533, 111 clinicians

Practice addresses (Care Compare)

10180 Washington Ave
Mount Pleasant, WI 53177-1604
Phone (414) 973-7830

12831 N Port Washington Rd
Mequon, WI 53097-2416
Phone (414) 973-7844

13111 N Port Washington Rd
Mequon, WI 53097-2416
Phone (262) 243-7300

2301 N Lake Dr
Milwaukee, WI 53211-4508
Phone (414) 585-1000

3237 S 16TH St
Milwaukee, WI 53215-4526
Phone (414) 647-5000

375 W River Woods Pkwy
Glendale, WI 53212-1080
Phone (414) 973-7842

3801 Spring St
Mount Pleasant, WI 53405-1667
Phone (262) 687-4011

3807 Spring St
Mount Pleasant, WI 53405-1667
Phone (262) 687-8300

3811 Spring St
Mount Pleasant, WI 53405-1667
Phone (262) 687-5300

5000 W Chambers St
Milwaukee, WI 53210-1650
Phone (414) 447-2000

9252 N Green Bay Rd
Brown Deer, WI 53209-1104
Phone (414) 270-8150

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia St. Mary's Hospital Milwaukee Inc CurrentSince Jan 28, 2019 Accepting new patients
M&S Radiology Associates, PA CurrentSince Jan 1, 2017 Accepting new patients
Premier Radiology Wisconsin, LLC Diagnostic Radiology CurrentSince Mar 28, 2020 Accepting new patients
Precision Radiology - Illinois LTD CurrentSince Feb 1, 2023 Accepting new patients
Wisconsin Radiology Specialists, S C CurrentSince Nov 28, 2018 Accepting new patients
Columbia St. Mary's Hospital Milwaukee, Inc CurrentSince Jan 28, 2019 Accepting new patients
VHS San Antonio Partners, LLC Past Accepting new patients
Sacred Heart Rehabilitation Institute, Inc. PastSince Jun 21, 2022 Accepting new patients
Allegheny Radiology Associates, LTD Diagnostic Radiology Past Accepting new patients

Locations

100 N River Rd
Des Plaines, IL 60016
Phone (847) 297-1800

3338 Oakwell Ct
Ste 106
San Antonio, TX 78218
Phone (210) 824-9311

311 Camden St
Ste 208
San Antonio, TX 78215
Phone (210) 227-6461

520 Madison Oak Dr
San Antonio, TX 78258
Phone (210) 297-0412

111 Dallas St
San Antonio, TX 78205
Phone (210) 297-7000

N112W15415 Mequon Rd
Germantown, WI 53022
Phone (262) 250-7800

6900 N Port Washington Rd
Glendale, WI 53217
Phone (414) 270-8100

13133 N Port Washington Rd
Ste 226
Mequon, WI 53097
Phone (262) 243-3660

500 W Brown Deer Rd
Ste 202
Milwaukee, WI 53217

2323 N Lake Dr
Milwaukee, WI 53211
Phone (414) 291-1000

10180 Washington Ave
Mount Pleasant, WI 53177
Phone (414) 769-4040

515 E Mill St
Plymouth, WI 53073
Phone (920) 892-2395

13111 N Port Washington Rd
Thiensville, WI 53097
Phone (262) 243-7300

10945 N Port Washington Rd
Ste 201
Thiensville, WI 53092
Phone (262) 478-0301

801 S 70th St
West Allis, WI 53214
Phone (414) 773-6600

Organizations & group practices 9

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 5

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": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700179200000",
    "number": "1346224839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10945 N PORT WASHINGTON RD STE 201",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925078",
            "telephone_number": "262-292-3151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10945 N PORT WASHINGTON RD STE 201",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925078",
            "telephone_number": "262-292-3151",
            "fax_number": "414-434-0467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICCARI",
        "first_name": "NICOLE",
        "middle_name": "GEORGANN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-30",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WI",
            "license": "70321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mequon, WI

Sources for this page

Verify at the official NPI Registry.