NPIMap

Individual provider Active NPI

Nicole McCrory Constantz Jernick, MD

  • Hospice and Palliative Medicine (Family Medicine) Physician
  • Truckee, CA
National Provider Identifier
1275928103
Registry record updated Aug 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Family Medicine) PhysicianTaxonomy code 207QH0002X
License
A146091 Issued in CA
Practice address
10121 Pine Ave
Truckee, CA 96161-4856
Phone
(530) 582-6432
Fax
(530) 582-6430
NPI assigned
Mar 28, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A146091 CA
Hospice and Palliative Medicine (Family Medicine) Physician 207QH0002X A146091 CA Primary

Addresses

Primary practice location

10121 Pine Ave
Truckee, CA 96161-4856

Mailing address

PO Box 759
Truckee, CA 96160-0759
Phone (530) 582-6432

Other practice location 1

880 Alder Ave
Incline Village, NV 89451-8335
Phone (775) 833-4100

Other names 1

  • Nicole McCrory Constantz Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20181024000575 CA Practitioner - Family Practice 7416200274 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Georgetown University School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tahoe Forest Hospital DistrictGroup PAC ID 0446161335, 140 clinicians

Practice addresses (Care Compare)

10121 Pine Ave
Truckee, CA 96161-4835
Phone (530) 587-6011

Hospital & facility affiliations

  • Tahoe Forest Hospice Hospice, Truckee, CA, CCN 051732
  • Tahoe Forest Hospital Hospital, Truckee, CA, CCN 051328
  • Plumas District Hospital Hospital, Quincy, CA, CCN 051326
  • Eastern Plumas Hospital - Portola Campus Hospital, Portola, CA, CCN 051300
  • Sierra Nevada Memorial Hospital Hospital, Grass Valley, CA, CCN 050150

Merit-based Incentive Payment System (MIPS)

Final score
75.06 of 100Reported as group
Quality
83.97
Promoting interoperability
88
Improvement activities
40
Cost
42.89

Merit-based Incentive Payment System (MIPS)

Final score
96.42 of 100Reported as group
Quality
93.48
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A146091CAMDHospice and Palliative Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tahoe Forest Hospital District CurrentSince May 15, 2023 Accepting new patients
Tahoe Forest Hospital District Current Accepting new patients
Tahoe Forest Hospital District Hospice and Palliative Medicine CurrentSince May 15, 2023 Accepting new patients

Locations

10121 Pine Ave
Fl 2
Truckee, CA 96161
Phone (530) 582-6368

10121 Pine Ave
Truckee, CA 96161
Phone (530) 582-3220

10051 Lake Ave
Ste 3
Truckee, CA 96161
Phone (530) 587-7461

880 Alder Ave
Incline Vlg, NV 89451
Phone (775) 831-6200

Organizations & group practices 12

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": "1427500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724371200000",
    "number": "1275928103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 759",
            "city": "TRUCKEE",
            "state": "CA",
            "postal_code": "961600759",
            "telephone_number": "530-582-6432",
            "fax_number": "530-582-6430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10121 PINE AVE",
            "city": "TRUCKEE",
            "state": "CA",
            "postal_code": "961614856",
            "telephone_number": "530-582-6432",
            "fax_number": "530-582-6430"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "880 Alder Ave",
            "address_purpose": "LOCATION",
            "city": "Incline Village",
            "state": "NV",
            "postal_code": "894518335",
            "country_code": "US",
            "telephone_number": "775-833-4100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JERNICK",
        "first_name": "NICOLE",
        "middle_name": "MCCRORY CONSTANTZ",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-28",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A146091",
            "primary": false
        },
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "CA",
            "license": "A146091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "CONSTANTZ",
            "middle_name": "MCCRORY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Truckee, CA

Sources for this page

Verify at the official NPI Registry.