Individual provider Active NPI

Madison Marie Nitschke

  • Physician Assistant
  • Jamestown, ND
National Provider Identifier
1245093087
Registry record updated Sep 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PAC1091 Issued in ND
Practice address
300 2ND Ave NE
Jamestown, ND 58401-3373
Phone
(701) 251-6000
NPI assigned
Feb 5, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X PAC1091 ND Primary

Addresses

Primary practice location

300 2ND Ave NE
Jamestown, ND 58401-3373

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074

Other practice location 1

7368 County Road 35
Jud, ND 58454-9759
Phone (701) 710-1267

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240923001774 ND Practitioner - Physician Assistant 7810438462 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
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

300 2ND Ave NE
Jamestown, ND 58401-3373
Phone (701) 251-6000

Hospital & facility affiliations

  • Sanford Medical Center Fargo Hospital, Fargo, ND, CCN 350011
  • Jamestown Regional Medical Center Hospital, Jamestown, ND, CCN 351335

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center Fargo CurrentSince Aug 26, 2024 Accepting new patients
Sanford Medical Center Fargo CurrentSince Aug 26, 2024 Accepting new patients
Sanford Medical Center Fargo Past Accepting new patients

Locations

503 Main St
Ste A
Edgeley, ND 58433
Phone (701) 493-2245

300 2nd Ave NE
Jamestown, ND 58401
Phone (701) 251-6000

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 and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1707091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726012800000",
    "number": "1245093087",
    "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": "300 2ND AVE NE",
            "city": "JAMESTOWN",
            "state": "ND",
            "postal_code": "584013373",
            "telephone_number": "701-251-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7368 County Road 35",
            "address_purpose": "LOCATION",
            "city": "Jud",
            "state": "ND",
            "postal_code": "584549759",
            "country_code": "US",
            "telephone_number": "701-710-1267",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NITSCHKE",
        "first_name": "MADISON",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-02-05",
        "last_updated": "2024-09-11",
        "certification_date": "2024-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ND",
            "license": "PAC1091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamestown, ND

Sources for this page

Verify at the official NPI Registry.