NPIMap

Individual provider Active NPI

Glenn A Nickele, MD

  • Cardiovascular Disease Physician
  • Saint Croix Falls, WI
National Provider Identifier
1093781452
Registry record updated Jun 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
32220 Issued in WI
Practice address
216 S Adams St
Saint Croix Falls, WI 54024-9449
Phone
(715) 483-3221
Fax
(715) 483-0507
NPI assigned
Feb 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 42548 MN
Cardiovascular Disease Physician 207RC0000X 32220 WI Primary

Addresses

Primary practice location

216 S Adams St
Saint Croix Falls, WI 54024-9449

Mailing address

235 State Street
St. Croix Falls, WI 54024-4117
Phone (715) 483-3261

Other practice location 1

640 Jackson St
MC 11102H
St Paul, MN 55101-2502
Phone (651) 254-5175

Other identifiers 1

IdentifierTypeStateIssuer
468980100MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040123000428 WI Practitioner - Cardiovascular Disease (Cardiology) 2567364128 Reassigns benefits to 4 organizations
I20120103000597 MN Practitioner - Cardiovascular Disease (Cardiology) 2567364128 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
University of Michigan Medical School, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. Croix Regional Medical CenterGroup PAC ID 9335032184, 131 clinicians

Practice addresses (Care Compare)

12375 Lindstrom LN
Lindstrom, MN 55045-9551
Phone (651) 400-2240

235 E State St
Saint Croix Falls, WI 54024-4117
Phone (715) 483-3221

235 State St
St Croix Falls, WI 54024-4117

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
42548MNMDCardiovascular Disease Physician
32220WIMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Group Health, Inc. CurrentSince Jan 1, 2016 Accepting new patients
Amery Regional Medical Center, Inc. CurrentSince Oct 30, 2020 Accepting new patients
Group Health, Inc. Current Accepting new patients
St. Croix Regional Medical Center CurrentSince Aug 26, 2003 Accepting new patients
Amery Regional Medical Center, Inc. CurrentSince Oct 30, 2020 Accepting new patients
St. Croix Regional Medical Center CurrentSince Aug 26, 2003 Accepting new patients
St. Croix Regional Medical Center Past Accepting new patients
University of Minnesota Physicians Past Accepting new patients
Iowa Heart Center PC Cardiovascular Disease Past Accepting new patients

Locations

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

640 Jackson St
#11102H
Saint Paul, MN 55101
Phone (651) 254-3462

640 Jackson St
Stop 11102H
Saint Paul, MN 55101

1500 Curve Crest Blvd W
Stillwater, MN 55082

921 Greeley St S
West Lakeland, MN 55082

265 Griffin St E
Amery, WI 54001
Phone (715) 268-0301

411 Stageline Rd
#200
Hudson, WI 54016
Phone (715) 531-6700

535 Hospital Rd
New Richmond, WI 54017
Phone (651) 292-2013

216 S Adams St
St Croix Fls, WI 54024
Phone (715) 483-0426

235 E State St
St Croix Fls, WI 54024
Phone (715) 483-3221

26425 Lakeland Ave S
Webster, WI 54893
Phone (715) 866-4271

Interoperability endpoints

  • Direct secure messaging: gnickele157412@excellian.direct.allina.com

Organizations & group practices 9

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.

Hospital & facility affiliations 21

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1140998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718150400000",
    "number": "1093781452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 STATE STREET",
            "city": "ST. CROIX FALLS",
            "state": "WI",
            "postal_code": "540244117",
            "telephone_number": "715-483-3261",
            "fax_number": "715-483-0507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 S ADAMS ST",
            "city": "SAINT CROIX FALLS",
            "state": "WI",
            "postal_code": "540249449",
            "telephone_number": "715-483-3221",
            "fax_number": "715-483-0507"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "640 Jackson St",
            "address_2": "MC 11102H",
            "address_purpose": "LOCATION",
            "city": "St Paul",
            "state": "MN",
            "postal_code": "551012502",
            "country_code": "US",
            "telephone_number": "651-254-5175",
            "fax_number": "651-254-1603",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICKELE",
        "first_name": "GLENN",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-27",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MN",
            "license": "42548",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WI",
            "license": "32220",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "468980100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Croix Falls, WI

Sources for this page

Verify at the official NPI Registry.