Nicole M Chickris-Bollaert, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036.130996 Issued in IL

Practice address

5401 44TH Avenue Dr Ste 101
Moline, IL 61265-8126

Phone

(309) 779-4050

NPI assigned

Jun 17, 2010

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Iowa Physicians Clinic Medical FoundationGroup PAC ID 8729992318, 1,254 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Unity Point at Home Home health agency, Moline, IL, CCN 147009
• Unitypoint Hospice Hospice, Moline, IL, CCN 141583
• Trinity Rock Island Hospital, Rock Island, IL, CCN 140280
• Trinity - Bettendorf Hospital, Bettendorf, IA, CCN 160104

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nchickris151866@direct.unitypoint.org

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.

• Iowa Physicians Clinic Medical Foundation

  dba UnityPoint Clinic

  • General Practice Physician
  • West Des Moines, IA
  • NPI 1366425274

  Family Medicine, IL

  Medicare reassignment Care Compare group NPD
• St Luke's Methodist Hospital

  • General Acute Care Hospital
  • Cedar Rapids, IA
  • NPI 1083708226
  NPD

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

• Trinity Medical Center

  dba Trinity Rock Island

  • General Acute Care Hospital
  • Rock Island, IL
  • NPI 1316047632
  Care Compare affiliation
• Unitypoint at Home

  • Home Health Agency
  • Moline, IL
  • NPI 1427351956
  Care Compare affiliation
• Unitypoint at Home

  dba UnityPoint Hospice

  • Community Based Hospice Care Agency
  • Moline, IL
  • NPI 1639472178
  Care Compare affiliation
• Trinity Medical Center

  dba Trinity Bettendorf

  • General Acute Care Hospital
  • Bettendorf, IA
  • NPI 1124110820
  Care Compare affiliation

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

{
    "created_epoch": "1276732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1922329507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 VALLEY VIEW DR",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612656138",
            "telephone_number": "309-792-9869",
            "fax_number": "309-762-2313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5401 44TH AVENUE DR STE 101",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612658126",
            "telephone_number": "309-779-4050"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "525 Valley View Dr",
            "address_purpose": "LOCATION",
            "city": "Moline",
            "state": "IL",
            "postal_code": "612656138",
            "country_code": "US",
            "telephone_number": "309-792-9869",
            "fax_number": "309-762-2313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHICKRIS-BOLLAERT",
        "first_name": "NICOLE",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-17",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": "125058663",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.130996",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036130996",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1922329507",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kevin Chanez, PHARMD
• Prasan Chariya, M.D.
• Dewat R Chaudhry, M.D
• Hogeun CHI
• James P Chiang, JAMES CHIANG D.D.S.
• Child & Family Psychology Center PC
• Poonputt Chotiprasidhi, M.D.
• Kimberly A Christensen, OTR/L
• Ronald G. Christensen, ED.D; CADC
• Natalie Ann Christenson

• Family Medicine Physician in Moline, IL
• Providers in Moline, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.