Individual provider Active NPI

Nicole Leann Wolken, PA-C

  • Physician Assistant
  • Urbana, IL
National Provider Identifier
1700669801
Registry record updated Mar 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
611 W Park St
Urbana, IL 61801-2501
Phone
(217) 383-3129
Fax
(217) 326-1550
NPI assigned
Aug 14, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X IL Primary

Addresses

Primary practice location

611 W Park St
Urbana, IL 61801-2501

Mailing address

611 W Park St
Urbana, IL 61801-2501
Phone (217) 383-3129

Other practice location 1

2693 County Road 1600 E
Rantoul, IL 61866-9534
Phone (217) 649-1090

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231122000474 IL Practitioner - Physician Assistant 8123476637 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

611 W Park St
Urbana, IL 61801-2500

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carle Health Care Incorporated CurrentSince Nov 13, 2023 Accepting new patients
Carle Health Care Incorporated Past Accepting new patients

Locations

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

Interoperability endpoints

  • Direct secure messaging: nwolkenpa391687@carlehiedirect.net

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1691971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709596800000",
    "number": "1700669801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W PARK ST",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012501",
            "telephone_number": "217-383-3129",
            "fax_number": "217-326-1550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 W PARK ST",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012501",
            "telephone_number": "217-383-3129",
            "fax_number": "217-326-1550"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2693 County Road 1600 E",
            "address_purpose": "LOCATION",
            "city": "Rantoul",
            "state": "IL",
            "postal_code": "618669534",
            "country_code": "US",
            "telephone_number": "217-649-1090",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WOLKEN",
        "first_name": "NICOLE",
        "middle_name": "LEANN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-14",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Urbana, IL

Sources for this page

Verify at the official NPI Registry.