Nicole Renee Nissen

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2018012260 Issued in MO

Practice address

623 Hamacher St
Waterloo, IL 62298-1786

Phone

(314) 925-0903

NPI assigned

May 23, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MO, IL2 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, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Generation Clinical Partners LLCGroup PAC ID 1557687803, shared by 2 NPIs, 24 clinicians

Pai Participant 27, PCGroup PAC ID 2668872672, 9 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Red Bud Regional Hospital Hospital, Red Bud, IL, CCN 141348

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nicole.nissen.1@9850.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/9850/brand/1/csg/1/fhir/r4

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.

• Pai Participant 27, PC

  • Geriatric Medicine (Internal Medicine) Physician
  • Willowbrook, IL
  • NPI 1093398539
  Medicare reassignment Care Compare group NPD
• Cep America - Illinois SNF, LLP

  • Internal Medicine Physician
  • Belleville, IL
  • NPI 1073069415
  Medicare reassignment NPD
• Generation Clinical Partners LLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Glen Carbon, IL
  • NPI 1366050007
  Medicare reassignment NPD
• Generation Clinical Partners LLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Saint Louis, MO
  • NPI 1104235241
  Medicare reassignment NPD
• Cep America - Illinois SNF LLP

  • Internal Medicine Physician
  • Edwardsville, IL
  • NPI 1043170434
  NPD
• Cep America - Illinois SNF, LLP

  • Internal Medicine Physician
  • Belleville, IL
  • NPI 1912453358
  NPD
• Generation Clinical Partners Aco, LLC

  • Internal Medicine Physician
  • Waterloo, IL
  • NPI 1104674431
  NPD
• Generation Clinical Partners Aco, LLC

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1740969120
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Deaconess Illinois Red Bud Regional Hospital Inc

  • Critical Access Hospital
  • Red Bud, IL
  • NPI 1407573132
  Care Compare affiliation

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

{
    "created_epoch": "1527033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1629569843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10426 BAUR BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631321905",
            "telephone_number": "314-925-0903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "623 HAMACHER ST",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622981786",
            "telephone_number": "314-925-0903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISSEN",
        "first_name": "NICOLE",
        "middle_name": "RENEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-23",
        "last_updated": "2025-04-17",
        "certification_date": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209017442",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2018012260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Franklin Murray, QMHP
• Ashlyn Makenzie Myers
• Katie Ione Neff, DC
• Diane Nelson, RSA
• Next Step Foot & Ankle Centers
• John H. Nobbe, D.C.
• Paul H. Nobbe, RPH
• Northland Hearing Centers, Inc.
• Joshua Allen Nurnberger, MHP
• Gabriella Rose Nuspl, RSA

• Family Nurse Practitioner in Waterloo, IL
• Providers in Waterloo, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2025; 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.