Jackie Rae Nord, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

2108 Issued in ND

Practice address

212 S 4TH St
Suite 101
Grand Forks, ND 58201-4777

Phone

(701) 757-2100

NPI assigned

Aug 20, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in ND

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Spectra Health

  • Federally Qualified Health Center (FQHC)
  • Larimore, ND
  • NPI 1255317905
  NPD (past)
• Spectra Health

  • Federally Qualified Health Center (FQHC)
  • Grand Forks, ND
  • NPI 1689878324
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571011200000",
    "number": "1043467152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 S 4TH ST STE 200",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014781",
            "telephone_number": "701-757-2100",
            "fax_number": "701-757-0305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 S 4TH ST",
            "address_2": "SUITE 101",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014777",
            "telephone_number": "701-757-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NORD",
        "first_name": "JACKIE",
        "middle_name": "RAE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-20",
        "last_updated": "2019-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ND",
            "license": "2108",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043467152",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40011",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nodak Optics Dba Pearle Vision
• Amy Noeldner, HIS
• Andrew Paul Norberg
• Nord Dentistry LTD
• Brian J Nord, DDS
• James C Nord, DDS
• John Oscar Nord, DDS
• Heidi Nordin
• Lauryn Nordine
• Melissa Nordrum

• Dentist in Grand Forks, ND
• Providers in Grand Forks, ND by specialty
• Dentist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.