Nicole M Vichunas, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601006549 Issued in MI

Practice address

25123 Culver St
Saint Clair Shores, MI 48081-2121

Phone

(248) 398-6459

NPI assigned

Oct 9, 2012

Last updated

Jan 16, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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 MI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: nicole.vichunas@bkguptamd.cernerdirect.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.

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  • NPI 1306937339
  Medicare reassignment
• Seniors Wellness Group of Michigan, P.C.

  • Clinical Psychologist
  • Royal Oak, MI
  • NPI 1801848718
  NPD (past)

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

{
    "created_epoch": "1349740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516060800000",
    "number": "1386996858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11900 E 12 MILE RD",
            "address_2": "STE 111",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480933487",
            "telephone_number": "248-398-6459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25123 CULVER ST",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480812121",
            "telephone_number": "248-398-6459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICHUNAS",
        "first_name": "NICOLE",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-09",
        "last_updated": "2018-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601006549",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas A. Verkest, M.A.,L.L.P,.
• Arunima Verma Jayakar, M.D.
• Marissa Verran, NP
• Rudy Jerome Vervaeke, M.D.
• VGW LLC (Park Pharmacy #2)
• Macayla View
• Cesar De Jesus Villa
• Michael Villa, HIS
• Ruth A. Villanueva
• Vincent R C Maribao MD PC

• Physician Assistant in Saint Clair Shores, MI
• Providers in Saint Clair Shores, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.