NICOLE SCHANTA RUSINOWSKI (A-GNP-C) – Nurse Practitioner, NPI 1558086819

NICOLE SCHANTA RUSINOWSKI (A-GNP-C) is a healthcare provider. based in Royal oak, Michigan. specializing in NURSE PRACTITIONER. They hold the professional credentials A-GNP-C. They hold a License No. 4704321524 (MI). The NPI Number for NICOLE SCHANTA RUSINOWSKI (A-GNP-C) is 1558086819

Main info

Female
Sole Proprietor
4 Years Of Experience
Accepts Medicare Assignment
Name
NICOLE SCHANTA RUSINOWSKI (A-GNP-C)
NPI
1558086819
Phone
(586) 524-5968
Address
1319 S WASHINGTON AVE
Enumeration Date
10 October 2022
Last Update Date
5 April 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3379919276
Graduation Year
2022 (4 years ago)
PAC ID
4183061724
Group Practice PAC ID
2961862800
Professional Enrollment ID
I20240319002145
Address ID
MI494233564HO5XXXXSTXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience30
Completeness75
Years active:3State licenses:1Digital endpointsOther names

8,105 NURSE PRACTITIONER in MI

Provider Addresses for NICOLE SCHANTA RUSINOWSKI (A-GNP-C)

  • 1319 S WASHINGTON AVE

    ROYAL OAK, MI 480673200

    Phone: (586) 524-5968

    Type: Mailing

  • 41800 W 11 MILE RD STE 109

    NOVI, MI 483751818

    Phone: (586) 524-5968

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

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: 2024-03-19

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

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

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20240319002145INurse PractitionerMITBD

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 48067)

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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: 2961862800View full group profile
NameSpecialtyState
Nurse PractitionerMI
Nurse PractitionerMI
Nurse PractitionerMI
Internal MedicineMI
Nurse PractitionerRI
Nurse PractitionerMI
Nurse PractitionerMI
Nurse PractitionerMI
Nurse PractitionerMI
Physician AssistantMI

Reviews

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Frequently asked questions

How do I look up NICOLE SCHANTA RUSINOWSKI (A-GNP-C) by NPI?
Use NPI 1558086819 when you need to reference NICOLE SCHANTA RUSINOWSKI (A-GNP-C) in forms, claims, or directories.
Is NICOLE SCHANTA RUSINOWSKI (A-GNP-C)'s enrollment marked active?
An active flag here means the NPI record is not in a deactivated state.
What does NICOLE SCHANTA RUSINOWSKI (A-GNP-C) treat or focus on?
Patients typically see NICOLE SCHANTA RUSINOWSKI (A-GNP-C) under the specialty Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Where is NICOLE SCHANTA RUSINOWSKI (A-GNP-C)'s primary listing?
We display Royal Oak, Michigan because that is what the record indicates for NICOLE SCHANTA RUSINOWSKI (A-GNP-C).
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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