Nicole Forrester Rucker, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN271979 Issued in GA

Practice address

3131 S Main St
Moultrie, GA 31768-6925

Phone

(229) 890-3418

NPI assigned

Feb 20, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Nicole Lee Forrester Other name

Medicare fee-for-service enrollment

Enrolled in GA, FL2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Privia Medical Group of Georgia LLCGroup PAC ID 4284951542, 454 clinicians

Villagehealth DM LLCGroup PAC ID 2769812445, 161 clinicians

Lifeline Vascular Center - Albany, LLCGroup PAC ID 2567607690, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: nicole.rucker.p91@direct.lifelinevascular.nextgenshare.com
• Direct secure messaging: nicole.rucker.1@8042.direct.athenahealth.com

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.

• Lifeline Vascular Center - Albany, LLC

  • Vascular Surgery Physician
  • Albany, GA
  • NPI 1861730855
  Medicare reassignment Care Compare group NPD
• Privia Medical Group of Georgia LLC

  • Internal Medicine Physician
  • Fayetteville, GA
  • NPI 1013313857

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Villagehealth DM LLC

  • Case Management Agency
  • Denver, CO
  • NPI 1598273211

  FL, GA

  Medicare reassignment Care Compare group
• Sterling Gynecologic Oncology LLC

  • Gynecologic Oncology Physician
  • Moultrie, GA
  • NPI 1366140246
  Medicare reassignment NPD
• Privia Medical Group of Georgia LLC

  • Internal Medicine Physician
  • Savannah, GA
  • NPI 1356907273

  Family Medicine

  NPD
• Sterling Gynecologic Oncology of Tallahassee

  • Gynecologic Oncology Physician
  • Tallahassee, FL
  • NPI 1659198141
  NPD (past)

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

{
    "created_epoch": "1708387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1467217232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 E WALTON ST",
            "city": "BACONTON",
            "state": "GA",
            "postal_code": "317167705",
            "telephone_number": "229-344-4497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3131 S MAIN ST",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686925",
            "telephone_number": "229-890-3418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUCKER",
        "first_name": "NICOLE",
        "middle_name": "FORRESTER",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-20",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN271979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "FORRESTER",
            "middle_name": "LEE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jermaine Marquis Robinson, DO
• Ronald E Trescot MD PC
• Caleb Joshua Rowan, MD
• Macy Micayle Rowan, DO
• Kathleen Rubino, ATC, LAT
• Lisa Ann Rudolph-Watson, MD
• Barbara Mae Runyan, R.D.L.D.
• Kelly Suzanne Rychener, NP
• S R Adcock MD PC
• Sacred Black Butterfly Doula Services, LLC.

• Family Nurse Practitioner in Moultrie, GA
• Providers in Moultrie, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 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.