Timothy P Nickell, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2892 Issued in WI

Practice address

331 S Main St
Rice Lake, WI 54868-2253

Phone

(715) 236-8500

NPI assigned

Mar 27, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WI

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

Physician Assistant

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mayo Clinic Health System-Northwest Wisconsin Region IncGroup PAC ID 4385553627, 797 clinicians

Lakeview Medical Center Inc of Rice LakeGroup PAC ID 6103737820, shared by 8 NPIs, 168 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Marshfield Medical Center - Rice Lake Home health agency, Rice Lake, WI, CCN 527158
• Mayo Clinic Health System-Northland Hospital, Barron, WI, CCN 521315
• Mayo Clinic Health System Eau Claire Hospital Hospital, Eau Claire, WI, CCN 520070
• Mayo Clinic Health System Chippewa Valley Hospital, Bloomer, WI, CCN 521314

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Mayo Clinic Health System-Northwest Wisconsin Region, Inc.

  • Critical Access Hospital
  • Barron, WI
  • NPI 1740239557
  Medicare reassignment Care Compare group NPD
• Amery Regional Medical Center, Inc.

  • Critical Access Hospital
  • Amery, WI
  • NPI 1093763518
  Medicare reassignment NPD
• Mayo Clinic Health System-Northwest Wisconsin Region, Inc.

  • Multi-Specialty Clinic/Center
  • Eau Claire, WI
  • NPI 1235588831
  Medicare reassignment
• Amery Regional Medical Center, Inc.

  • Rural Health Clinic/Center
  • Luck, WI
  • NPI 1851345268

  Physician Assistant

  NPD
• Mayo Clinic Health System-Northwest Wisconsin Region, Inc.

  • Rural Health Clinic/Center
  • Mondovi, WI
  • NPI 1174116669
  NPD
• Mayo Clinic Health System-Northwest Wisconsin Region, Inc.

  • Multi-Specialty Clinic/Center
  • Barron, WI
  • NPI 1518494244
  NPD
• Mayo Clinic Health System-Northwest Wisconsin Region, Inc.

  • Critical Access Hospital
  • Bloomer, WI
  • NPI 1700837812
  NPD (past)

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

• Lakeview Medical Center Inc of Rice Lake

  • Home Health Agency
  • Rice Lake, WI
  • NPI 1326139049
  Care Compare affiliation
• Mayo Clinic Health System-Northwest Wisconsin Region, Inc.

  • General Acute Care Hospital
  • Eau Claire, WI
  • NPI 1629027578
  Care Compare affiliation
• Mayo Clinic Health System-Northwest Wisconsin Region, Inc.

  • Critical Access Hospital
  • Bloomer, WI
  • NPI 1700837812
  Care Compare affiliation
• Mayo Clinic Health System-Northwest Wisconsin Region, Inc.

  • Critical Access Hospital
  • Barron, WI
  • NPI 1740239557
  Care Compare affiliation

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

{
    "created_epoch": "1332806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612310400000",
    "number": "1346516044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 1ST ST SW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559050001",
            "telephone_number": "715-838-5222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "331 S MAIN ST",
            "city": "RICE LAKE",
            "state": "WI",
            "postal_code": "548682253",
            "telephone_number": "715-236-8500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "265 Griffin St E",
            "address_purpose": "LOCATION",
            "city": "Amery",
            "state": "WI",
            "postal_code": "540011439",
            "country_code": "US",
            "telephone_number": "715-635-2151",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 1st St SW",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "MN",
            "postal_code": "559050001",
            "country_code": "US",
            "telephone_number": "507-284-2511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICKELL",
        "first_name": "TIMOTHY",
        "middle_name": "P",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-03-27",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "2892-23",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tnickell24484@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "331 S Main St",
            "city": "Rice Lake",
            "state": "WI",
            "country_code": "US",
            "postal_code": "548682253",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Brian Nelson
• Jack Orrin Nelson, PT
• Selena Ann Nelson
• Tonja Marie Nelson, H.I.S
• New Richmond Family Care, LLC
• Riley Niebuhr, FNP
• Timothy M Nispel
• Erin Ann Nolin, FNP
• Northview Eye Associates LLC
• Northwest Wisconsin Anesthesiologists, SC

• Physician Assistant in Rice Lake, WI
• Providers in Rice Lake, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2021; 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.