Individual provider Active NPI

Nicola Wissler, LCSW

  • Clinical Social Worker
  • Perryville, MO
National Provider Identifier
1700152691
Registry record updated Nov 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
2012002519 Issued in MO
Practice address
12 N Kingshighway St Ste 101
Perryville, MO 63775-1367
Phone
(573) 547-3116
NPI assigned
Mar 26, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 2012002519 MO Primary

Addresses

Primary practice location

12 N Kingshighway St Ste 101
Perryville, MO 63775-1367

Mailing address

12 N Kingshighway St Ste 101
Perryville, MO 63775-1367
Phone (573) 547-3116

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120802000597 MO Practitioner - Clinical Social Worker 0143476325 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Hospital PerryGroup PAC ID 1153777826, 115 clinicians

Practice addresses (Care Compare)

12 N Kingshighway
100 Wound Care
Perryville, MO 63775-1367
Phone (573) 768-3399

1508 Edgemont Blvd
Primary Care/Convenient Care
Perryville, MO 63775-1231
Phone (573) 768-3220

206 Hospital LN
Perryville, MO 63775-1382

210 Hospital LN
Perryville, MO 63775-4200

210 Hospital LN
Suite 203
Perryville, MO 63775-1276
Phone (573) 768-3285

212 Hospital LN
Perryville, MO 63775-4204

434 N W St
Perryville, MO 63775-1359
Phone (573) 547-2536

624 Old Saint Marys Rd
Suite a
Perryville, MO 63775-1844
Phone (573) 768-3284

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2012002519MOMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital Perry Current Accepting new patients
Mercy Hospital Perry CurrentSince Oct 10, 2023 Accepting new patients
Mercy Clinic Adult Psychiatry, LLC CurrentSince Jan 1, 2024 Accepting new patients
Mercy Hospital Perry PastSince Nov 12, 2023 Accepting new patients

Locations

212 Hospital Ln
Ste 101
Perryville, MO 63775
Phone (573) 547-7888

12 N Kingshighway St
#101
Perryville, MO 63775
Phone (573) 547-3116

434 N West St
Perryville, MO 63775
Phone (573) 547-2530

12125 Conway Rd
Ste 160
Saint Louis, MO 63141
Phone (314) 251-2870

Organizations & group practices 4

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": "1332720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699488000000",
    "number": "1700152691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 N KINGSHIGHWAY ST STE 101",
            "city": "PERRYVILLE",
            "state": "MO",
            "postal_code": "637751367",
            "telephone_number": "573-547-3116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 N KINGSHIGHWAY ST STE 101",
            "city": "PERRYVILLE",
            "state": "MO",
            "postal_code": "637751367",
            "telephone_number": "573-547-3116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISSLER",
        "first_name": "NICOLA",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-26",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2012002519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Perryville, MO

Sources for this page

Verify at the official NPI Registry.