Nichole Christine Rave, PA-C

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

085009019 Issued in IL

Practice address

1404 Eastland Dr Ste 204
Bloomington, IL 61701-7904

Phone

(309) 662-8813

NPI assigned

Apr 21, 2015

Last updated

May 24, 2024By 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 3

Addresses

Other names 1

• Nichole Christine Sheehan Former name

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

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Associates in Dermatology SCGroup PAC ID 8921084476, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Associates in Dermatology SC

  • Dermatology Physician
  • Bloomington, IL
  • NPI 1689863904
  Medicare reassignment Care Compare group
• Gibson Community Hospital Association

  dba Gibson Area Hospital and Health Services

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)

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

{
    "created_epoch": "1429574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716508800000",
    "number": "1386031045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1404 EASTLAND DR STE 204",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617017904",
            "telephone_number": "309-662-8813",
            "fax_number": "309-662-6835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1404 EASTLAND DR STE 204",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617017904",
            "telephone_number": "309-662-8813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAVE",
        "first_name": "NICHOLE",
        "middle_name": "CHRISTINE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-21",
        "last_updated": "2024-05-24",
        "certification_date": "2024-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "085009019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICHOLE",
            "last_name": "SHEEHAN",
            "middle_name": "CHRISTINE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Gregory Marshall Randolph, D,D.S.
• Laura C Randolph, M.D.
• Amanda M Ratesic
• Sara Renee Rauen Dardis, DDS, MS
• Nita Raut, APN
• Bernadette Ray, MD
• William John Ray, M.D.
• Johanna Rayman, LCSW
• Janet Reckard, LCSW, ACSW
• Alissa Recker, P.T.

• Dermatology Physician in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2024; 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.