Individual provider Active NPI

Nicole M Wysocki, MD

  • Physical Medicine & Rehabilitation Physician
  • Chicago, IL
National Provider Identifier
1386858413
Registry record updated Jun 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
036-115589 Issued in IL
Practice address
355 E Erie St
Chicago, IL 60611-3167
Phone
(312) 238-1000
NPI assigned
May 9, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 036-115589 IL Primary

Addresses

Primary practice location

355 E Erie St
Chicago, IL 60611-3167

Mailing address

355 E Erie St
Chicago, IL 60611-3167
Phone (312) 238-1000

Other identifiers 1

IdentifierTypeStateIssuer
036115589MedicaidIL

Other names 1

  • Nicole M. Otanicar Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address nwysocki@direct.ric.org Other

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070709000012 IL Practitioner - Physical Medicine and RehabilitationPractitioner - Pain Management 0547360489 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Northwestern University Feinberg Medical School, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medical Services RicGroup PAC ID 4880598978, 92 clinicians

Practice addresses (Care Compare)

355 E Erie St
Chicago, IL 60611-3167
Phone (312) 238-1000

Hospital & facility affiliations

  • Shirley Ryan Abilitylab Inpatient rehabilitation facility, Chicago, IL, CCN 143026

Merit-based Incentive Payment System (MIPS)

Final score
84.56 of 100Reported as group
Quality
75.1
Promoting interoperability
100
Improvement activities
40
Cost
48.11

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Rehabilitation Institute of Chicago Physical Medicine & Rehabilitation CurrentSince Jul 30, 2019 Accepting new patients
Medical Services Ric Physical Medicine & Rehabilitation CurrentSince Jul 16, 2007 Accepting new patients

Locations

2757 Solution Ctr
Chicago, IL 60677

935 Beisner Rd
Elk Grove Vlg, IL 60007
Phone (847) 319-3660

800 Biesterfield Rd
Ste 635
Elk Grove Vlg, IL 60007
Phone (847) 631-5664

19260 Halsted St
Homewood, IL 60430
Phone (312) 238-2160

120 N Oak St
Oak Brook Mall, IL 60521
Phone (630) 856-6700

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1178668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656028800000",
    "number": "1386858413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 E ERIE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113167",
            "telephone_number": "312-238-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 E ERIE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113167",
            "telephone_number": "312-238-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYSOCKI",
        "first_name": "NICOLE",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-09",
        "last_updated": "2022-06-24",
        "certification_date": "2022-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "IL",
            "license": "036-115589",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036115589",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nwysocki@direct.ric.org",
            "affiliation": "N",
            "endpointDescription": "Shirley Ryan AbilityLab",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "referrals",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "xml",
            "address_1": "355 E Erie St",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606113167",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "OTANICAR",
            "middle_name": "M.",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.