NPIMap

Individual provider Active NPI

Nicole Poythress Waters, DO, PHD

  • Family Medicine Physician
  • Carrier Mills, IL
National Provider Identifier
1407416308
Registry record updated Feb 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036157809 Issued in IL
Practice address
7211 US 45 S
Carrier Mills, IL 62917-1305
Phone
(618) 294-8247
Fax
(618) 294-8247
NPI assigned
Jun 13, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036157809 IL Primary

Addresses

Primary practice location

7211 US 45 S
Carrier Mills, IL 62917-1305

Mailing address

PO Box 155
Christopher, IL 62822-0155
Phone (618) 724-2401

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220510001024 IL Practitioner - Family Practice 2769717040 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

7211 US 45
Carrier Mills, IL 62917-1305
Phone (618) 294-8246

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
036157809ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Christopher Greater Area Rural Health Planning Corporation Family Medicine Current Accepting new patients
Integritas Emergency Physician Services, LLC CurrentSince Feb 1, 2022 Accepting new patients
Christopher Greater Area Rural Health Planning Corporation CurrentSince Aug 24, 2023 Accepting new patients
Christopher Greater Area Rural Health Planning Corporation Family Medicine CurrentSince Aug 24, 2023 Accepting new patients
Shawnee Health Service and Development Corp CurrentSince Sep 12, 2022 Accepting new patients
Statera Health Care, LLC CurrentSince Jul 1, 2023 Accepting new patients
Shawnee Health Service and Development Corp Family Medicine CurrentSince Sep 12, 2022 Accepting new patients
Shawnee Health Service and Development Corp Family Medicine Current Accepting new patients

Locations

2250 N Illinois Ave
Carbondale, IL 62901
Phone (618) 833-1691

103 Commerce St
Carmi, IL 62821
Phone (618) 384-5686

7211 US 45 S
Ste C
Carrier Mills, IL 62917
Phone (618) 994-2321

1006 S Division St
Carterville, IL 62918
Phone (618) 985-4841

4241 State Highway 14
Christopher, IL 62822
Phone (618) 724-2136

4241 Highway 14 W
Christopher, IL 62822
Phone (618) 724-1684

1401 US Highway 45 N
Eldorado, IL 62930
Phone (618) 273-2951

3303 Logan Dr
Herrin, IL 62948
Phone (618) 833-4471

14410 Route 37
Johnston City, IL 62951
Phone (618) 937-6409

3111 Williamson County Pkwy
Marion, IL 62959
Phone (618) 997-3647

611 S Marshall Ave
Mc Leansboro, IL 62859
Phone (618) 542-2146

28 Chick St
Metropolis, IL 62960
Phone (618) 427-2680

9525 Gold Hill Rd
Shawneetown, IL 62984
Phone (618) 269-3454

Interoperability endpoints

  • Direct secure messaging: nwaters@yourcarecommunity.org
  • Direct secure messaging: nicole.waters@crhpc.eclinicaldirectplus.com

Organizations & group practices 8

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 6

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": "1560384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770336000000",
    "number": "1407416308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 155",
            "city": "CHRISTOPHER",
            "state": "IL",
            "postal_code": "628220155",
            "telephone_number": "618-724-2401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7211 US 45 S",
            "city": "CARRIER MILLS",
            "state": "IL",
            "postal_code": "629171305",
            "telephone_number": "618-294-8247",
            "fax_number": "618-294-8247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERS",
        "first_name": "NICOLE",
        "middle_name": "POYTHRESS",
        "name_prefix": "Dr.",
        "credential": "DO, PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-13",
        "last_updated": "2026-02-06",
        "certification_date": "2026-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036157809",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrier Mills, IL

Sources for this page

Verify at the official NPI Registry.