Pamela Jean Niksich, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

45836 Issued in MN

Practice address

12720 Bass Lake Rd
Maple Grove, MN 55369-6307

Phone

(763) 559-2861

Fax

(763) 559-1338

NPI assigned

Dec 16, 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

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Children'S Clinic Network

  • Primary Care Clinic/Center
  • Hugo, MN
  • NPI 1447529235
  Medicare reassignment NPD
• Children'S Clinic Network

  • Primary Care Clinic/Center
  • Brooklyn Park, MN
  • NPI 1588522668
  NPD
• Central Pediatrics, P.a.

  • Primary Care Clinic/Center
  • Woodbury, MN
  • NPI 1396721387
  NPD (past)
• Pediatric Surgical Associates LTD

  • Pediatric Surgery Physician
  • Minneapolis, MN
  • NPI 1093778292
  NPD (past)

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

{
    "created_epoch": "1134691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465430400000",
    "number": "1063498673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12720 BASS LAKE RD",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553696307",
            "telephone_number": "763-559-2861",
            "fax_number": "763-559-1338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12720 BASS LAKE RD",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553696307",
            "telephone_number": "763-559-2861",
            "fax_number": "763-559-1338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIKSICH",
        "first_name": "PAMELA",
        "middle_name": "JEAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-16",
        "last_updated": "2016-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "45836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Khoa Nguyen
• Teresa Nguyen
• Jennifer K Nhan, MD
• Ryan C Nielsen, DO, MSC
• Evelyn F Nietfeld, APRN, CNP
• Jessica Jean Niles
• Jeffrey H.J. Nipper, MD
• Nahashon M Njagi
• Matthew S. Nolan
• Sarah Joan Noonan, P.T.

• Pediatrics Physician in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Pediatrics Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2016; 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.