NICOLE LEIGH FORNALIK (PA-C) – Physician Assistant, NPI 1982635587
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,499 PHYSICIAN ASSISTANT in IN
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Provider Addresses for NICOLE LEIGH FORNALIK (PA-C)
Michiana Hematology and Oncology, 5340, Holy Cross Parkway, Mishawaka, Saint Joseph County, Indiana, 46545, United States
MISHAWAKA, IN 465451470
Phone: (574) 237-1328
Fax: (574) 237-1348
Type: Location
100 E WAYNE ST STE 510
SOUTH BEND, IN 466012394
Phone: (574) 334-5400
Type: Mailing
5340 Holy Cross Pkwy
Mishawaka, IN 465451470
Phone: (574) 237-1328
Fax: (574) 237-1348
Type: Location
8040 CLEARVISTA PKWY STE 490
INDIANAPOLIS, IN 462565604
Phone: (317) 621-5450
Fax: (317) 621-5453
Type: Location
6626 E 75TH ST STE 500
INDIANAPOLIS, IN 462502890
Phone:
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 12 Open Payments records for all available years, with a total value of $311.
Total Amount is formed as General ($311) + Research ($0) + Ownership ($0) = $311.
Last reported payment date: 2024-12-10 • Largest payer in this snapshot: TACTILE SYSTEMS TECHNOLOGY INC ($111).
Total Amount
$311
General + Research + Ownership
Payments
12
Total payment records
General Amount
$311
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-10
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| TACTILE SYSTEMS TECHNOLOGY INC | $111 |
| GlaxoSmithKline, LLC. | $66 |
| Smith+Nephew, Inc. | $34 |
| Merck Sharp & Dohme LLC | $25 |
| Genmab U.S., Inc. | $21 |
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: 2006-09-29
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20060929000360 | I | Physician Assistant | IN | TBD |
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.
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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 18 | 16 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 15 | 14 | $0 |
Insurance plans in this area (ZIP 46545)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Cardiac Electrophysiology | NV | |
| Family Practice | IN | |
| - | IN | |
| - | IN | |
| Physician Assistant | IN | |
| Geriatric Medicine | IN | |
| Family Practice | IN | |
| - | IN | |
| Nurse Practitioner | IN | |
| Nurse Practitioner | IN |
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