NICOLE A. WIZEMAN (PA-C) – Surgical Physician Assistant, NPI 1134511595

NICOLE A. WIZEMAN (PA-C) is a healthcare provider. based in Manchester, Connecticut. specializing in PHYSICIAN ASSISTANT. They hold the professional credentials PA-C. They hold a License No. 3298 (CT). The NPI Number for NICOLE A. WIZEMAN (PA-C) is 1134511595

Main info

Female
12 Years Of Experience
Accepts Medicare Assignment
Name
NICOLE A. WIZEMAN (PA-C)
NPI
1134511595
Phone
(860) 533-6595
Address
71 HAYNES ST
Enumeration Date
23 February 2015
Last Update Date
30 January 2017

Doctor Profile

Medical School Name
OTHER
Secondary Phone
4134526251
Graduation Year
2014 (12 years ago)
PAC ID
4688993157
Group Practice PAC ID
4385907609
Professional Enrollment ID
I20191111001399
Address ID
MA011043404SP401XXSTXX300
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience45
Completeness75
Years active:11State licenses:2Digital endpointsOther names

3,244 PHYSICIAN ASSISTANT in CT

Provider Addresses for NICOLE A. WIZEMAN (PA-C)

  • 71 HAYNES ST

    MANCHESTER, CT 060404131

    Phone: (860) 533-6595

    Fax: (860) 533-6594

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 2 Open Payments records for all available years, with a total value of $43.

Total Amount is formed as General ($43) + Research ($0) + Ownership ($0) = $43.

Last reported payment date: 2024-08-02 • Largest payer in this snapshot: Smith+Nephew, Inc. ($26).

Total Amount

$43

General + Research + Ownership

Payments

2

Total payment records

General Amount

$43

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-08-02

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2019-11-11

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking 2 Medicare enrollment records; no due dates published yet.

Enrollment records

2

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20150505001133IPhysician AssistantCTTBD
I20191111001399IPhysician AssistantMATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 06040)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4385907609View full group profile
NameSpecialtyState
Physician AssistantMA
-VA
Physician AssistantMA
Orthopedic SurgeryMA
Physician AssistantMA
Orthopedic SurgeryMA
Orthopedic SurgeryMA
Orthopedic SurgeryRI

Reviews

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Frequently asked questions

How do I look up NICOLE A. WIZEMAN (PA-C) by NPI?
Use NPI 1134511595 when you need to reference NICOLE A. WIZEMAN (PA-C) in forms, claims, or directories.
Is NICOLE A. WIZEMAN (PA-C) active in the national directory?
NICOLE A. WIZEMAN (PA-C)'s public NPI profile is in an active state.
What kind of provider is NICOLE A. WIZEMAN (PA-C)?
The page reflects Surgical Physician Assistant for NICOLE A. WIZEMAN (PA-C). Clinical services aligned with this taxonomy classification.
Where does public data place NICOLE A. WIZEMAN (PA-C)?
The snapshot lists Manchester, Connecticut for NICOLE A. WIZEMAN (PA-C); download NPPES for the complete set.
Is NICOLE A. WIZEMAN (PA-C) a real provider?
This page reflects official NPPES data for NPI 1134511595. Always confirm identity and privileges with the practice and licensing boards.