Individual provider Active NPI

Nicolette Winterscheidt, PA-C

  • Physician Assistant
  • Stillwater, OK
National Provider Identifier
1730675307
Registry record updated Jul 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
604 S Walnut St
Stillwater, OK 74074-4222
Phone
(405) 372-2202
Fax
(405) 445-3780
NPI assigned
Jul 7, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2019

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 Primary

Addresses

Primary practice location

604 S Walnut St
Stillwater, OK 74074-4222

Mailing address

604 S Walnut St
Stillwater, OK 74074-4222
Phone (405) 372-2202

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20190808000421 OK Practitioner - Physician Assistant 2567799984 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Grand Lake Mental Health Center, Inc.Group PAC ID 4688711534, 121 clinicians

Practice addresses (Care Compare)

111 S Treaty Rd
Miami, OK 74354-5327
Phone (918) 540-1511

6128 E 38TH St
Tulsa, OK 74135-5832
Phone (918) 779-7144

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2916OKMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Grand Lake Mental Health Center, Inc. CurrentSince Jul 15, 2019 Accepting new patients
Grand Lake Mental Health Center, Inc. CurrentSince Jul 15, 2019 Accepting new patients

Locations

111 S Treaty Rd
Miami, OK 74354
Phone (918) 540-1511

114 W Delaware Ave
Nowata, OK 74048
Phone 91827318412207

604 S Walnut St
Stillwater, OK 74074
Phone (405) 338-7072

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1530921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562544000000",
    "number": "1730675307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 S WALNUT ST",
            "city": "STILLWATER",
            "state": "OK",
            "postal_code": "740744222",
            "telephone_number": "405-372-2202",
            "fax_number": "405-445-3780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 S WALNUT ST",
            "city": "STILLWATER",
            "state": "OK",
            "postal_code": "740744222",
            "telephone_number": "405-372-2202",
            "fax_number": "405-445-3780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WINTERSCHEIDT",
        "first_name": "NICOLETTE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-07",
        "last_updated": "2019-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stillwater, OK

Sources for this page

Verify at the official NPI Registry.