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DR. NICOLE MARIE SUDHOLT D.M.D.
NPI 1184915431
Dentist in Peoria, IL

Active since April 20, 2011Opted out of Medicare · through Mar 2, 2028
843 W GLEN AVE, PEORIA, IL 61614(309) 691-9421 Get Directions Write a Review

NPPES record last updated: April 20, 2011. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Dr. Nicole Marie Sudholt D.m.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. NICOLE MARIE SUDHOLT D.M.D. (NPI 1184915431) is an individual dentist in Peoria, Illinois, licensed in Illinois (019028323) and active in the NPI registry since April 2011. She has opted out of Medicare through March 2, 2028 and remains eligible to order and refer.

NPPES Registry Identity

NPI1184915431
Entity TypeIndividualFemale
Primary Taxonomy122300000X
Provider Legal NameDR. NICOLE MARIE SUDHOLTCredential: D.M.D.
Location Address843 W GLEN AVEPeoria, IL 61614-4834
Mailing Address843 W Glen AvePeoria, IL 61614-4834 · (309) 691-9421
Phone(309) 691-9421
Sole ProprietorNo
Enumeration DateApril 20, 2011
✔ NPI 1184915431 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in IL · 019028323
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
843 W GLEN AVE, Peoria, IL 61614
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Nicole Marie Sudholt D.m.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from March 2, 2016 through March 2, 2028.

Opt-Out Effective DateMarch 2, 2016
Opt-Out In Effect ThroughMarch 2, 2028Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 61614 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.71 typical visit price
range $54.80 – $168.44
Typical copayment $21.42 (range $13.70 – $42.11)
Most-billed visit code 99203
Established Patient
$68.64 typical visit price
range $17.16 – $136.56
Typical copayment $17.16 (range $4.29 – $34.14)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. KATHERINE MAE SHADID DMD
Dentist
843 W GLEN AVE
PEORIA, IL 61614
Peoria County (309) 691-9421
DONLAN DENTAL GROUP
Dentist (General Practice)
843 W GLEN AVE
PEORIA, IL 61614
Peoria County (309) 691-9421

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nicole Sudholt's NPI number?

The NPI number for Nicole Sudholt is 1184915431. It was assigned to this individual provider in the NPPES registry on April 20, 2011.

Where is Nicole Sudholt located?

Nicole Sudholt practices at 843 W Glen Ave, Peoria, IL 61614. The listed phone number is (309) 691-9421.

What is Nicole Sudholt's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Is Nicole Sudholt enrolled in Medicare?

No. Nicole Sudholt has opted out of Medicare through March 2, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Nicole Sudholt was last updated on April 20, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.