NPIMap

Individual provider Active NPI

Christina Marie Waddle, FNP

  • Nurse Practitioner
  • Fargo, ND
National Provider Identifier
1225762107
Registry record updated Feb 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
R36497 Issued in ND
Practice address
801 Broadway N
Fargo, ND 58102-3641
Phone
(701) 234-2000
NPI assigned
Jul 15, 2022
Last updated
Feb 6, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R36497 ND
Nurse Practitioner 363L00000X R36497 ND Primary

Addresses

Primary practice location

801 Broadway N
Fargo, ND 58102-3641

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230302002516 ND Practitioner - Nurse Practitioner 1052784519 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford Medical Center FargoGroup PAC ID 8426967803, 1,210 clinicians

Practice addresses (Care Compare)

1220 Sheyenne St
West Fargo, ND 58078-2637
Phone (701) 234-4445

5225 23Rd Ave S
Fargo, ND 58104-7927
Phone (701) 417-2575

618 14TH Ave NE
Devils Lake, ND 58301-2808
Phone (701) 544-7000

801 Broadway N
Fargo, ND 58102-3641
Phone (701) 234-2000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.39 of 100Reported as group
Quality
91.62
Promoting interoperability
100
Improvement activities
40
Cost
66.36

Merit-based Incentive Payment System (MIPS)

Final score
82.73 of 100Reported as group
Quality
71.75
Promoting interoperability
100
Improvement activities
40
Cost
70.68

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center Fargo CurrentSince Feb 6, 2023 Accepting new patients
Sanford Medical Center Fargo CurrentSince Feb 6, 2023 Accepting new patients
Sanford Clinic North Past Accepting new patients

Locations

801 Broadway N
Fargo, ND 58102
Phone (701) 234-5121

5225 23rd Ave S
Fargo, ND 58104
Phone (701) 234-5933

1720 University Dr S
Fargo, ND 58103
Phone (701) 280-4140

736 Broadway N
Fargo, ND 58102
Phone (701) 234-2353

1220 Sheyenne St
West Fargo, ND 58078
Phone (701) 234-4445

Organizations & group practices 3

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

Hospital & facility affiliations 10

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

NPI Registry JSON

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

{
    "created_epoch": "1657843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675641600000",
    "number": "1225762107",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 BROADWAY N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581023641",
            "telephone_number": "701-234-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADDLE",
        "first_name": "CHRISTINA",
        "middle_name": "MARIE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-15",
        "last_updated": "2023-02-06",
        "certification_date": "2022-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ND",
            "license": "R36497",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ND",
            "license": "R36497",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.