Nicole Ann Hartsough, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Practice address

7402 E Riverside Blvd
Loves Park, IL 61111-5630

Phone

(815) 226-9642

Fax

(815) 226-9672

NPI assigned

Jul 10, 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

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

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

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 and National Provider Directory roles.

• Rockford Health Physicians

  • Multi-Specialty Clinic/Center
  • Rockford, IL
  • NPI 1043242886
  Medicare reassignment NPD

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

{
    "created_epoch": "1120953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192665600000",
    "number": "1962400382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7402 E RIVERSIDE BLVD",
            "city": "LOVES PARK",
            "state": "IL",
            "postal_code": "611115630",
            "telephone_number": "815-226-9642",
            "fax_number": "815-226-9672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7402 E RIVERSIDE BLVD",
            "city": "LOVES PARK",
            "state": "IL",
            "postal_code": "611115630",
            "telephone_number": "815-226-9642",
            "fax_number": "815-226-9672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARTSOUGH",
        "first_name": "NICOLE",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-07-10",
        "last_updated": "2007-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nathan J Hahn, M.D.
• Ashley Hall, CRNA
• Sue Hansen, LMT
• Harmony Center for Holistic Psychotherapy
• Ethan S Harris, CRNA
• Morgan Hatch, LCPC
• Sarah Elizabeth Hawkins, M.P.T.
• Healing Pathways, PLLC
• Dylan Heine, DPT
• Meghan Erin Hembrough

• Dermatology Physician in Loves Park, IL
• Providers in Loves Park, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.