Nichole Suzanne Suckow, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085-002146 Issued in IL

Practice address

912 N Henrietta St
Effingham, IL 62401-1788

Phone

(217) 342-3337

Fax

(217) 342-3338

NPI assigned

Sep 21, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Nichole Suzanne Myers Former name

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

Specialty

Physician Assistant

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Effingham Obstetrics and Gynecology Associates PLLCGroup PAC ID 2961726021, 12 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Anthonys Memorial Hospital Hospital, Effingham, IL, CCN 140032

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nichole.suckow.1@29023.direct.athenahealth.com

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.

• Effingham Obstetrics and Gynecology Associates PLLC

  • Obstetrics & Gynecology Physician
  • Effingham, IL
  • NPI 1649677063
  Medicare reassignment Care Compare group
• Effingham Obstetrics & Gynecology Associates SC

  • Obstetrics & Gynecology Physician
  • Effingham, IL
  • NPI 1134251853

  Single Specialty

  NPD
• Together Women's Health Medical Group of Illinois, PLLC

  • Specialist
  • Chicago, IL
  • NPI 1912161100

  Single Specialty

  NPD (past)

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

• St Anthonys Memorial Hospital of the Hospital Sisters of the Third

  dba St. Anthony's Memorial Hospital

  • General Acute Care Hospital
  • Effingham, IL
  • NPI 1306800602
  Care Compare affiliation
• St Anthonys Memorial Hospital of the Hospital Sisters of the Third

  dba St. Anthony's Memorial Hospitral

  • Clinic/Center
  • Effingham, IL
  • NPI 1881214104

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1127260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320192000000",
    "number": "1902892318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 784",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624010784",
            "telephone_number": "217-342-3337",
            "fax_number": "217-342-3338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "912 N HENRIETTA ST",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624011788",
            "telephone_number": "217-342-3337",
            "fax_number": "217-342-3338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUCKOW",
        "first_name": "NICHOLE",
        "middle_name": "SUZANNE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-09-21",
        "last_updated": "2011-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-002146",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICHOLE",
            "last_name": "MYERS",
            "middle_name": "SUZANNE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kourtney Stombaugh
• Bethany Renee Stone
• Erica Storck, LMT
• Sara Stremming, MPH
• Beth Stundon
• Katherine A Summers
• Rosalie Swaine, OTR
• Jay Ivor Swanson, D.D.S.,M.D.
• T Square Unlimited LLC
• Jordan Michael Tanner, QMHP, PEL, MS

• Physician Assistant in Effingham, IL
• Providers in Effingham, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.