Nova Integrated Care LLC

Primary specialty

Clinic/CenterTaxonomy code 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

Last updated

Oct 18, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jill Brunstad, PANPI 1902861131

Title

Owner/Physician Assistant

Phone

(715) 891-0088

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jill K Brunstad, PA

  • Physician Assistant
  • Eagle River, WI
  • NPI 1902861131
  Medicare reassignment Care Compare group Authorized official
• Marina Montserrat McKissack, PA-C

  • Physician Assistant
  • Rhinelander, WI
  • NPI 1114957198
  Medicare reassignment Care Compare group
• Stacy Lynn Winter, PAC

  • Medical Physician Assistant
  • Minocqua, WI
  • NPI 1104866763
  Medicare reassignment Care Compare group
• Adrienne Laverdure, MD

  • Family Medicine Physician
  • Watersmeet, MI
  • NPI 1639119225

  WI

  Medicare reassignment NPD

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

{
    "created_epoch": "1697587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697587200000",
    "number": "1679355358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 W PINE ST STE 2",
            "city": "EAGLE RIVER",
            "state": "WI",
            "postal_code": "545219349",
            "telephone_number": "715-891-0088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 W PINE ST STE 2",
            "city": "EAGLE RIVER",
            "state": "WI",
            "postal_code": "545219349",
            "telephone_number": "715-891-0088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVA INTEGRATED CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-18",
        "last_updated": "2023-10-18",
        "certification_date": "2023-10-18",
        "status": "A",
        "authorized_official_last_name": "BRUNSTAD",
        "authorized_official_first_name": "JILL",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "715-891-0088",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Northwoods Dental Sleep Therapy Inc
• Annette M Numrich, OTR-L
• David William Peterson, RPH
• Jenna M Peterson, DPT
• Rebecca E Pflughoeft, NP
• Potrykus Family Dentistry LLC

• Clinic/Center in Eagle River, WI
• Providers in Eagle River, WI by specialty
• Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2023; 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.