Niccole J Mack, D.P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1225 Issued in SD

Practice address

901 4TH St NW
Watertown, SD 57201-1558

Phone

(605) 886-8471

Fax

(605) 886-9317

NPI assigned

Oct 18, 2005

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 1

Other names 1

• Niccole J Riddle Former name

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sanford Medical CenterGroup PAC ID 8325950215, 847 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

84.78 of 100Reported as group

Quality

78.77

Promoting interoperability

100

Improvement activities

40

Cost

70.49

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Sanford Medical Center

  • Family Medicine Physician
  • Sioux Falls, SD
  • NPI 1093090342
  Medicare reassignment Care Compare group NPD
• Sanford Clinic

  • Psychologist
  • Sioux Falls, SD
  • NPI 1396764254
  Medicare reassignment NPD
• Sanford Clinic

  • Family Medicine Physician
  • Watertown, SD
  • NPI 1801840632
  NPD
• Sanford Clinic

  • Diagnostic Radiology Physician
  • Fargo, ND
  • NPI 1306641345
  NPD
• TLC Physical Therapy Inc

  • Specialist
  • Webster, SD
  • NPI 1417139890
  NPD (past)

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

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383609600000",
    "number": "1063401503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074",
            "telephone_number": "605-328-6585",
            "fax_number": "605-328-6512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 4TH ST NW",
            "city": "WATERTOWN",
            "state": "SD",
            "postal_code": "572011558",
            "telephone_number": "605-886-8471",
            "fax_number": "605-886-9317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "NICCOLE",
        "middle_name": "J",
        "credential": "D.P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-18",
        "last_updated": "2013-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SD",
            "license": "1225",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5834040",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICCOLE",
            "last_name": "RIDDLE",
            "middle_name": "J",
            "credential": "D.P.T.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Salena Lundquist, FNP-BC
• Seth Luoma
• Katerina Elise Lykins
• Salem N Maaliki, MD
• Emma R. Mack, D.C.
• Todd D Mack, CSW-PIP
• Brittany Elaine Macks
• Teresa Ann Madsen, CCSC II BS ALLIED
• Melissa J Magstadt, CNP
• Gertrude Boitumelo Makgabenyana, MA CLINICAL MENTAL

• Physical Therapist in Watertown, SD
• Providers in Watertown, SD by specialty
• Physical Therapist in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.