NICOLE RENEE NISSEN – Family Nurse Practitioner, NPI 1629569843

NICOLE RENEE NISSEN is a healthcare provider. based in Saint louis, Missouri. specializing in NURSE PRACTITIONER. They hold a License No. 209017442 (IL). The NPI Number for NICOLE RENEE NISSEN is 1629569843

Main info

Female
9 Years Of Experience
Accepts Medicare Assignment
Name
NICOLE RENEE NISSEN
NPI
1629569843
Phone
(314) 925-0903
Address
10426 BAUR BLVD
Enumeration Date
23 May 2018
Last Update Date
17 April 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3149250903
Graduation Year
2017 (9 years ago)
PAC ID
0547519423
Group Practice PAC ID
1557687803
Professional Enrollment ID
I20180827001542
Address ID
MO631226508SA1111XRDXX400
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience54
Completeness75
Years active:8State licenses:2Digital endpointsOther names

11,632 NURSE PRACTITIONER in IL

Provider Addresses for NICOLE RENEE NISSEN

  • 10426 BAUR BLVD

    SAINT LOUIS, MO 631321905

    Phone: (314) 925-0903

    Type: Mailing

  • 623 HAMACHER ST

    WATERLOO, IL 622981786

    Phone: (314) 925-0903

    Type: Location

  • 121 SAINT LUKES CENTER DR STE 403

    CHESTERFIELD, MO 630173519

    Phone: (314) 205-6149

    Type: Location

  • 210, Northeast Tudor Road, AMLI Summit Ridge, Lee's Summit, Jackson County, Missouri, 64086, United States

    LEES SUMMIT, MO 640865696

    Phone: (888) 256-3814

    Fax: (888) 256-9054

    Type: Mailing

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: 2018-09-10

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
I20180827001542INurse PractitionerMOTBD
I20180910002278INurse PractitionerILTBD

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99309Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes1,222147$0
99310Subsequent nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes29682$0
99308Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes3619$0
99316Nursing facility discharge management, more than 30 minutes1111$0
View full utilization report →

Insurance plans in this area (ZIP 63132)

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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: 1557687803View full group profile
NameSpecialtyState
Nurse PractitionerMO
Family Practice, HospitalistMO
Internal MedicineIL
Internal MedicineMI
Nurse PractitionerIL
Hospitalist, Internal MedicineMO
Internal MedicineMO

Reviews

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Frequently asked questions

What is the 10-digit NPI for NICOLE RENEE NISSEN?
NICOLE RENEE NISSEN — NPI 1629569843 — is the standard way to identify this listing.
Does the file indicate NICOLE RENEE NISSEN is practicing under active NPI?
Directory data currently reports NICOLE RENEE NISSEN as active.
What healthcare role does NICOLE RENEE NISSEN hold?
Scheduling teams often label NICOLE RENEE NISSEN under Family Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Does NICOLE RENEE NISSEN list a practice location?
Patients near Saint Louis, Missouri may find NICOLE RENEE NISSEN in results; validate coverage separately.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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