Alicia Mae Mack, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R39910 Issued in ND

Practice address

212 S. 4TH St. Suite 301
Spectra Health
Grand Forks, ND 58201

Phone

(701) 757-2100

Fax

(701) 757-2813

NPI assigned

Jun 25, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Miss Alicia Mae Erickson Former name

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: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Spectra HealthGroup PAC ID 8022075258, 12 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Altru Hospital Hospital, Grand Forks, ND, CCN 350019

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Spectra Health

  • Federally Qualified Health Center (FQHC)
  • Grand Forks, ND
  • NPI 1114343423
  Medicare reassignment Care Compare group NPD
• Spectra Health

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

  • Federally Qualified Health Center (FQHC)
  • Grand Forks, ND
  • NPI 1841953379
  NPD (past)

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

• Altru Health System

  • General Acute Care Hospital
  • Grand Forks, ND
  • NPI 1154346161
  Care Compare affiliation

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

{
    "created_epoch": "1529884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582502400000",
    "number": "1225523004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 S. 4TH ST. SUITE 301",
            "address_2": "SPECTRA HEALTH",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "58201",
            "telephone_number": "701-757-2100",
            "fax_number": "701-757-2813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 S. 4TH ST. SUITE 301",
            "address_2": "SPECTRA HEALTH",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "58201",
            "telephone_number": "701-757-2100",
            "fax_number": "701-757-2813"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "607 Towner Ave",
            "address_purpose": "LOCATION",
            "city": "Larimore",
            "state": "ND",
            "postal_code": "582514501",
            "country_code": "US",
            "telephone_number": "701-318-9399",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACK",
        "first_name": "ALICIA",
        "middle_name": "MAE",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-25",
        "last_updated": "2020-02-24",
        "certification_date": "2020-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "2344340",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "ND",
            "license": "R39910",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ND",
            "license": "R39910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALICIA",
            "last_name": "ERICKSON",
            "middle_name": "MAE",
            "prefix": "MISS",
            "credential": "FNP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lvctr PLLC
• Madison Lynch
• Derek John Lyste, MD
• M.S. Johnson PC
• Mark John Macgregor, M.D.
• Travis Eugene Mackenzie, OT
• Trisha Mackenzie
• Kamrin L Macki, FNP-C
• Brett Macleod, M.D.
• John Madden, PH.D.

• Family Nurse Practitioner in Grand Forks, ND
• Providers in Grand Forks, ND by specialty
• Family Nurse Practitioner in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2020; 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.
• 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.