Nova Integrated Care LLC
Organization Active NPI Clinic/Center · Eagle River, WI
NPI 1679355358 · NPPES record last updated Oct 18, 2023
Key facts
- NPI
- 1679355358
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- NOVA INTEGRATED CARE LLC
- Practice address
- 302 W Pine St Ste 2
Eagle River, WI 54521-9349 - Phone
- (715) 891-0088
- NPI assigned
- Oct 18, 2023
- Organization subpart
- No
Authorized official
- Name
- Jill Brunstad, PA
- Title
- Owner/Physician Assistant
- Phone
- (715) 891-0088
Practitioners 4
-
Jill K Brunstad, PA
-
Stacy Lynn Winter, PAC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 52D2321775 | Nova Integrated Care | Certificate of waiver | Apr 8, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240226001791 | WI | Part B Supplier - Clinic/Group Practice | 2860837291 |
Receives reassigned benefits from 4 practitioners Practice locations: Eagle River, WI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Yes |
Addresses
Primary practice location
302 W Pine St Ste 2
Eagle River, WI 54521-9349
Mailing address
302 W Pine St Ste 2
Eagle River, WI 54521-9349
Phone (715) 891-0088
Other providers in Eagle River, WI
- Northern Wisconsin Bone & Joint Center, LTD
- Northland Hearing Centers, Inc.
- Northland Pines School District
- Northwest Counseling & Guidance Clinic, Inc.
- Northwoods Dental Sleep Therapy Inc
- Annette M Numrich
- David William Peterson
- Jenna M Peterson
- Rebecca E Pflughoeft
- Potrykus Family Dentistry LLC
All providers in Eagle River, WI · Clinic/Center in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 18, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.