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NICOLE BRANDI PEDTKE FNP
NPI 1326664111
Nurse Practitioner - Family in Ashley, IL

Active since June 17, 2020PECOS EnrolledAccepts Medicare Assignment
96.98/100
CMS Quality Rating
5680 INDIAN TRAIL RD, ASHLEY, IL 62808(618) 713-3811 Get Directions Write a Review

NPPES record last updated: June 23, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jun 23, 2020, Jun 17, 2020 (2 updates tracked since 2020).

About Nicole Brandi Pedtke Fnp NPPES

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

NICOLE BRANDI PEDTKE FNP (NPI 1326664111) is an individual family provider in Ashley, Illinois, licensed in Illinois (209021411) and active in the NPI registry since June 2020. She is enrolled in Medicare PECOS, is affiliated with Ssm Health St Mary's Hospital -centralia, and is a graduate of Other (2020).

NPPES Registry Identity

NPI1326664111
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameNICOLE BRANDI PEDTKECredential: FNP
Location Address5680 INDIAN TRAIL RDAshley, IL 62808-2527
Mailing Address5680 Indian Trail RdAshley, IL 62808-2527 · (618) 713-3811
Phone(618) 713-3811
Sole ProprietorNo
Medical School CMSOtherGraduated 2020
Enumeration DateJune 17, 2020
Last NPPES UpdateJune 23, 20202 updates tracked since enumeration
NPPES CertifiedJune 23, 2020
✔ NPI 1326664111 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in IL · 209021411
5680 INDIAN TRAIL RD, Ashley, IL 62808
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Nicole Brandi Pedtke Fnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5799190609
PECOS Enrollment IDI20210225003198
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Nicole Pedtke reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

St. Mary's Hospital, Centralia, Illinois
18 mi
Anesthesiology
400 N PLEASANT AVE
Centralia, IL 62801
  • Reassigned Medicare billing, Illinois enrollment
  • Medicare enrollment name: St Marys Hospital Centralia Illinois
  • 392 clinicians in this Medicare group
NPI 1477097871 (618) 436-6056
Physician Services Corporation Of Southern Illinois Inc.
19 mi
Internal Medicine
4218 LINCOLNSHIRE DR
Mount Vernon, IL 62864
  • Reassigned Medicare billing, Illinois enrollment
  • 296 clinicians in this Medicare group
NPI 1831101807 (618) 899-3600

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 8

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
153 services59 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
76 services52 patients
Injection of drug or substance under skin or into muscle 96372
This procedure involves administering medication directly under the skin or into a muscle. A small needle is used to inject the drug, allowing it to be absorbed quickly into the bloodstream. It's a common method for delivering a variety of medications.
45 services21 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
38 services38 patients
Insertion of needle into vein for collection of blood sample 36415
This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.
23 services20 patients
Removal of skin and tissue, 20.0 sq cm or less 11042
This procedure involves the surgical removal of skin and tissue, up to 20.0 square cm in size. It's often performed to treat conditions like skin cancer or to remove moles, warts, and other skin lesions. The area is numbed and the unwanted tissue is carefully cut out.
22 services19 patients

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Ssm Health St Mary's Hospital -Centralia

Acute Care Hospitals · Centralia, IL
3/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number140034
Location400 North Pleasant AvenueCentralia, IL 62801 · Marion County
Emergency services

Good Samaritan Regional Hlth Center

Acute Care Hospitals · Mount Vernon, IL
2/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number140046
Location1 Good Samaritan WayMount Vernon, IL 62864 · Jefferson County
Emergency services Birthing friendly

Washington County Hospital

Critical Access Hospitals · Nashville, IL
OwnershipGovernment - Hospital District or Authority
CMS Certification Number141308
Location705 S Grand AveNashville, IL 62263 · Washington County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 62808 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
$88.44 typical visit price
range $56.28 – $173.35
Typical copayment $22.11 (range $14.07 – $43.33)
Most-billed visit code 99203
Established Patient
$99.71 typical visit price
range $17.51 – $139.99
Typical copayment $24.92 (range $4.37 – $34.99)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

96.98/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality83.89
Promoting Interoperability100
Improvement Activities40
Cost80

Referred Medical Equipment & Supplies CMS DME claims 5

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing A6402
DME-Medical/Surgical Supplies · category DA023N
3 suppliers12 claims376 services$0.11 avg. paid by Medicare
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard A6446
DME-Medical/Surgical Supplies · category DA023N
4 suppliers14 claims1,565 services$0.35 avg. paid by Medicare
Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories A6550
DME-Other DME · category DE000N
2 suppliers13 claims155 services$22.80 avg. paid by Medicare
Canister, disposable, used with suction pump, each A7000
DME-Other DME · category DE000N
2 suppliers11 claims90 services$7.06 avg. paid by Medicare
Negative pressure wound therapy electrical pump, stationary or portable E2402
DME-Other DME · category DE000N
2 suppliers13 claims13 services$934.96 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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 Pedtke's NPI number?

The NPI number for Nicole Pedtke is 1326664111. It was assigned to this individual provider in the NPPES registry on June 17, 2020.

Where is Nicole Pedtke located?

Nicole Pedtke practices at 5680 Indian Trail Rd, Ashley, IL 62808. The listed phone number is (618) 713-3811.

What is Nicole Pedtke's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Nicole Pedtke enrolled in Medicare?

Yes. Nicole Pedtke is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Nicole Pedtke's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Nicole Pedtke reassigns Medicare benefits to 2 organizations: St. Mary's Hospital, Centralia, Illinois (Centralia, IL) and Physician Services Corporation Of Southern Illinois Inc. (Mount Vernon, IL). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Nicole Pedtke's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

Is Nicole Pedtke affiliated with any hospitals?

According to CMS data, Nicole Pedtke is affiliated with Ssm Health St Mary's Hospital -Centralia, Good Samaritan Regional Hlth Center and Washington County Hospital.

When was this NPI record last updated?

The NPPES record for Nicole Pedtke was last updated on June 23, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.