Nicole Marie Wolf, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

5884 Issued in CT

Practice address

130 Division St
Derby, CT 06418-1326

Phone

(203) 732-1330

Fax

(203) 732-1332

NPI assigned

Sep 13, 2022

Last updated

Jan 8, 2024By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

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

Merit-based Incentive Payment System (MIPS)

Final score

90.42 of 100Reported as group

Quality

83.36

Promoting interoperability

100

Improvement activities

40

Cost

75.9

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Hartford Healthcare Medical Group Specialists, PLLC

  • Surgery Physician
  • Hartford, CT
  • NPI 1023584216

  Surgical

  Medicare reassignment NPD
• Griffin Faculty Physicians, Inc.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Derby, CT
  • NPI 1598755605
  Medicare reassignment
• Hartford Healthcare Medical Group Specialists LLC

  • Customized Equipment (DME)
  • Groton, CT
  • NPI 1295367068
  NPD

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

{
    "created_epoch": "1663027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704672000000",
    "number": "1932821345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 MAPLE AVE",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "064181328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 DIVISION ST",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "064181326",
            "telephone_number": "203-732-1330",
            "fax_number": "203-732-1332"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2800 Main St",
            "address_purpose": "LOCATION",
            "city": "Bridgeport",
            "state": "CT",
            "postal_code": "066064292",
            "country_code": "US",
            "telephone_number": "203-576-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WOLF",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-13",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CT",
            "license": "5884",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Jean Wengertsman, MS, LPC
• Wholeperson Therapeutics LLC
• Wholesoul LLC
• Dorothea Wild, M.D.
• Jennifer Anne Williams, PA-C
• Abigail Davis Wolff-France, LMFT
• Lihong Xia, MD
• Mark Yerushalmi
• Tiji Saji Zehring, PA
• Larissa Zepko-March, RD, CDN

• Surgical Physician Assistant in Derby, CT
• Providers in Derby, CT by specialty
• Surgical Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2024; 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.