Individual provider Active NPI

Nicole Tomlin, DPT

  • Physical Therapist
  • Lake Geneva, WI
National Provider Identifier
1689385700
Registry record updated Dec 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
16089-24 Issued in WI
Practice address
N2950 State Road 67
Lake Geneva, WI 53147-2655
Phone
(262) 245-0535
Fax
(262) 245-2248
NPI assigned
Dec 9, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 16089-24 WI Primary

Addresses

Primary practice location

N2950 State Road 67
Lake Geneva, WI 53147-2655

Mailing address

2019 Craig LN W
Onalaska, WI 54650-9072
Phone (608) 797-5794

Other identifiers 1

IdentifierTypeStateIssuer
225100000XMedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221222001985 WI Practitioner - Physical Therapist in Private Practice 0345610952 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Health System CorporationGroup PAC ID 7416860440, 749 clinicians

Practice addresses (Care Compare)

N2950 State Rd
Suite 67
Lake Geneva, WI 53147-2655
Phone (262) 245-0535

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
16089-24WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health System Corporation Current Accepting new patients
Mercy Health System Corporation CurrentSince Dec 12, 2022 Accepting new patients
Mercy Health System Corporation CurrentSince Dec 12, 2022 Accepting new patients

Locations

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

1000 Mineral Point Ave
Janesville, WI 53548
Phone (608) 261-6868

N2950 State Road 67
Lake Geneva, WI 53147
Phone (262) 245-0535

Interoperability endpoints

  • Direct secure messaging: ntomlin98855@direct.mhemail.org

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1670544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670544000000",
    "number": "1689385700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2019 CRAIG LN W",
            "city": "ONALASKA",
            "state": "WI",
            "postal_code": "546509072",
            "telephone_number": "608-797-5794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N2950 STATE ROAD 67",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531472655",
            "telephone_number": "262-245-0535",
            "fax_number": "262-245-2248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOMLIN",
        "first_name": "NICOLE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-09",
        "last_updated": "2022-12-09",
        "certification_date": "2022-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "16089-24",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "225100000X",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Geneva, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 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.