NPIMap

Individual provider Active NPI

Nathan Tiedeman, DNP, FNP, RN

  • Family Nurse Practitioner
  • Sisseton, SD
National Provider Identifier
1285083436
Registry record updated Jun 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
CP001093 Issued in SD
Practice address
205 Orchard Dr
Sisseton, SD 57262-2312
Phone
(605) 698-7647
NPI assigned
Jun 8, 2016
Last updated
Jun 13, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X CP001093 SD Primary

Addresses

Primary practice location

205 Orchard Dr
Sisseton, SD 57262-2312

Mailing address

205 Orchard Dr
Sisseton, SD 57262-2312
Phone (605) 698-7647

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, MN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160801000663 ND Practitioner - Nurse Practitioner 1153613906 Reassigns benefits to 3 organizations
I20210505001615 MN Practitioner - Nurse Practitioner 1153613906 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Glacial Ridge Hospital DistrictGroup PAC ID 5294789194, shared by 7 NPIs, 69 clinicians

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

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
CP001093SDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Glacial Ridge Hospital District CurrentSince Feb 1, 2021 Accepting new patients
Lisbon Area Health Services CurrentSince Jun 1, 2020 Accepting new patients
Mercy Hospital of Devils Lake CurrentSince Jul 15, 2016 Accepting new patients
Glacial Ridge Hospital District Current Accepting new patients
Mercy Hospital CurrentSince Feb 10, 2020 Accepting new patients
Mercy Hospital of Valley City Current Accepting new patients
Glacial Ridge Hospital District Current Accepting new patients
Mercy Hospital of Devils Lake CurrentSince Jul 15, 2016 Accepting new patients
Lisbon Area Health Services CurrentSince Jun 1, 2020 Accepting new patients
Mercy Hospital of Valley City CurrentSince Feb 10, 2020 Accepting new patients
Coteau Des Prairies Hospital,Inc Past Accepting new patients
Glacial Ridge Hospital District Past Accepting new patients

Locations

3265 Solutions Ctr
Chicago, IL 60677

3276 Solutions Ctr
Chicago, IL 60677

3290 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

  • FHIR API: https://fhir-usa.unify.chbase.com/org/glac-1755385c

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1465344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465776000000",
    "number": "1285083436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 ORCHARD DR",
            "city": "SISSETON",
            "state": "SD",
            "postal_code": "572622312",
            "telephone_number": "605-698-7647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 ORCHARD DR",
            "city": "SISSETON",
            "state": "SD",
            "postal_code": "572622312",
            "telephone_number": "605-698-7647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIEDEMAN",
        "first_name": "NATHAN",
        "name_prefix": "Mr.",
        "credential": "DNP, FNP, RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-08",
        "last_updated": "2016-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SD",
            "license": "CP001093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sisseton, SD

Sources for this page

Verify at the official NPI Registry.