Nicole Wallis

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Practice address

3000 N State Rd 135
Greenwood, IN 46143

Phone

(800) 777-7775

NPI assigned

Jan 5, 2022

Last updated

Jan 5, 2022By the provider in NPPES

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 IN

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

CHN JMH Ventures LLCGroup PAC ID 3870728512, 20 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• CHN JMH Ventures LLC

  dba Stones Crossing PT & Rehabilitation

  • Physical Therapist
  • Greenwood, IN
  • NPI 1902242084

  Occupational Therapist

  Medicare reassignment Care Compare group NPD
• CHN JMH Ventures LLC

  dba Stones Crossing Imaging Services

  • Radiology Clinic/Center
  • Greenwood, IN
  • NPI 1134564016
  NPD

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

{
    "created_epoch": "1641340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641340800000",
    "number": "1629739206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 N DEQUINCY ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462012844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 N STATE RD 135",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "46143",
            "telephone_number": "800-777-7775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-05",
        "last_updated": "2022-01-05",
        "certification_date": "2022-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225XN1300X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Neurorehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Howard Walker, D.D.S.
• Jacob B Wall, PA-C
• Gabriel Wallace, RBT
• Jennifer Brooke Wallem, OTR
• Janine Elise Wallick, NP
• Kerri Raye Walls, PT, CLT, LANA
• Laura Walradth
• Debrah Sue Waltke, OTR
• John Adam Walton, O.T.R.
• Matthew R Walton, DDS

• Occupational Therapist in Greenwood, IN
• Providers in Greenwood, IN by specialty
• Occupational Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.