Nathan Tiedeman, DNP, FNP, RN
Individual provider Active NPI Family Nurse Practitioner · Sisseton, SD
NPI 1285083436 · NPPES record last updated Jun 13, 2016
Key facts
- NPI
- 1285083436
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- CP001093 (SD)
- Practice address
- 205 Orchard Dr
Sisseton, SD 57262-2312 - Phone
- (605) 698-7647
- NPI assigned
- Jun 8, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 15
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Glacial Ridge Hospital District
Practice addresses (Care Compare)
10 4TH Ave SE
Glenwood, MN 56334-1820
Phone (320) 634-4521
417 Franklin St S
Glenwood, MN 56334-1518
Phone (320) 634-5157
Hospital & facility affiliations
- Glacial Ridge Hospital
- Prairie Ridge Hospital and Health Services
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ND, MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160801000663 | ND | Practitioner - Nurse Practitioner | 1153613906 | Reassigns benefits to 3 organizations |
| I20210505001615 | MN | Practitioner - Nurse Practitioner | 1153613906 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CP001093 | SD | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lisbon Area Health Services | Current |
Accepting new patients | |
| Mercy Hospital of Valley City | Current |
Accepting new patients | |
| Lisbon Area Health Services | Current |
Accepting new patients | |
| Mercy Hospital of Devils Lake | Current |
Accepting new patients | |
| Mercy Hospital of Devils Lake | Current |
Accepting new patients | |
| Glacial Ridge Hospital District | Current | Accepting new patients | |
| Glacial Ridge Hospital District | Current | Accepting new patients | |
| Mercy Hospital | Current |
Accepting new patients | |
| Glacial Ridge Hospital District | Current |
Accepting new patients | |
| Mercy Hospital of Valley City | Current | Accepting new patients | |
| Coteau Des Prairies Hospital,Inc | Past | Accepting new patients | |
| Glacial Ridge Hospital District | Past | Accepting new patients |
Locations
3290 Solutions Ctr
Chicago, IL 60677
3276 Solutions Ctr
Chicago, IL 60677
3265 Solutions Ctr
Chicago, IL 60677
10 4th Ave SE
Glenwood, MN 56334
Phone (320) 634-5157
417 Franklin St S
Glenwood, MN 56334
Phone (320) 634-5157
1031 7th St NE
Devils Lake, ND 58301
Phone (701) 662-2131
570 Chautauqua Blvd
Valley City, ND 58072
Phone (701) 845-0440
Interoperability endpoints
- https://fhir-usa.unify.chbase.com/org/glac-1755385c
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | CP001093 | SD | Yes |
Addresses
Primary practice location
205 Orchard Dr
Sisseton, SD 57262-2312
Mailing address
205 Orchard Dr
Sisseton, SD 57262-2312
Phone (605) 698-7647
Other providers in Sisseton, SD
- Tandem Healthcare Inc.
- Tekakwitha Nursing Center Inc
- Leah Meyer Thielen
- Paul William Thielen
- Mary Jo Thoennes
- Sherryl J. Tomboulian
- US Dept of Health & Human Services
- Jodie Webb
- Leah Adele Weiss
- Dana Marie Wilson
All providers in Sisseton, SD · Family Nurse Practitioner in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.