NPIMap

Individual provider Active NPI

Nicholas Vincent Diflavio, PA-C

  • Medical Physician Assistant
  • Saint Croix Falls, WI
National Provider Identifier
1831933589
Registry record updated Apr 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
7992 Issued in WI
Practice address
235 E State St
Saint Croix Falls, WI 54024-4117
Phone
(715) 483-3261
Fax
(678) 325-0317
NPI assigned
Jun 19, 2024
Last updated
Apr 3, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 3, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 14937 MN
Physician Assistant 363A00000X 7992-23 WI
Medical Physician Assistant 363AM0700X 14937 MN
Medical Physician Assistant 363AM0700X 7992 WI Primary

Addresses

Primary practice location

235 E State St
Saint Croix Falls, WI 54024-4117

Mailing address

235 E State St
Saint Croix Falls, WI 54024-4117
Phone (715) 483-3261

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ndiflavio670537@excellian.direct.allina.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240903001553 WI Practitioner - Physician Assistant 5799224804 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. Croix Regional Medical CenterGroup PAC ID 9335032184, 131 clinicians

Practice addresses (Care Compare)

235 E State St
Saint Croix Falls, WI 54024-4117
Phone (715) 483-3221

235 State St
St Croix Falls, WI 54024-4117

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
14937MNMDPhysician Assistant
7992-23WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St. Croix Regional Medical Center CurrentSince Aug 13, 2024 Accepting new patients
St. Croix Regional Medical Center CurrentSince Aug 13, 2024 Accepting new patients
St. Croix Regional Medical Center Past Accepting new patients

Locations

216 S Adams St
St Croix Fls, WI 54024
Phone (715) 483-0426

235 E State St
St Croix Fls, WI 54024
Phone (715) 483-3221

26425 Lakeland Ave S
Webster, WI 54893
Phone (715) 866-4271

Interoperability endpoints

  • Direct secure messaging: ndiflavio670537@excellian.direct.allina.com

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.

Hospital & facility affiliations 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1718755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743638400000",
    "number": "1831933589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 E STATE ST",
            "city": "SAINT CROIX FALLS",
            "state": "WI",
            "postal_code": "540244117",
            "telephone_number": "715-483-3261",
            "fax_number": "678-325-0317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 E STATE ST",
            "city": "SAINT CROIX FALLS",
            "state": "WI",
            "postal_code": "540244117",
            "telephone_number": "715-483-3261",
            "fax_number": "678-325-0317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIFLAVIO",
        "first_name": "NICHOLAS",
        "middle_name": "VINCENT",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-06-19",
        "last_updated": "2025-04-03",
        "certification_date": "2025-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "14937",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "7992-23",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MN",
            "license": "14937",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "7992",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ndiflavio670537@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "235 E State St",
            "city": "Saint Croix Falls",
            "state": "WI",
            "country_code": "US",
            "postal_code": "540244117",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Croix Falls, WI

Sources for this page

Verify at the official NPI Registry.