NPIMap

Individual provider Active NPI

David Ernest Niccum, M.D.

  • Pulmonary Disease Physician
  • Saint Paul, MN
National Provider Identifier
1316110869
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
56658 Issued in MN
Practice address
640 Jackson St
Ms 11502B
St. Paul, MN 55101-2502
Phone
(651) 254-3135
Fax
(651) 254-3048
NPI assigned
Apr 4, 2008
Last updated
Mar 17, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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 NU
Pulmonary Disease Physician 207RP1001X 56658 MN Primary

Addresses

Primary practice location

640 Jackson St
Ms 11502B
St. Paul, MN 55101-2502

Mailing address

8170 33Rd Ave S
Ms 21110Q
Minneapolis, MN 55425-0341

Other practice location 1

420 Delaware St SE
Pulmonary MMC: 276
Minneapolis, MN 55455-0341
Phone (612) 624-0999

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20140731002969 MN Practitioner - Pulmonary DiseasePractitioner - Internal MedicinePractitioner - Pediatric Medicine 4789849712 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Internal Medicine, Pediatric Medicine
Education
St. Louis College of Physicians and Surgeons, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Group Health IncGroup PAC ID 1759293954, 1,627 clinicians

Practice addresses (Care Compare)

15245 Bluebird NWST
Andover, MN 55304-3554
Phone (763) 712-6000

401 Phalen Blvd
Saint Paul, MN 55130-5302
Phone (651) 254-7400

435 Phalen Blvd
Saint Paul, MN 55130-5302
Phone (651) 291-2848

640 Jackson St
Saint Paul, MN 55101-2502
Phone (651) 221-3456

8600 Nicollet Ave
Bloomington, MN 55420-2824
Phone (952) 884-1148

927 Churchill W St
Stillwater, MN 55082-6605
Phone (651) 439-5330

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
56658MNMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic CurrentSince Sep 1, 2014 Accepting new patients
Group Health, Inc. CurrentSince May 1, 2016 Accepting new patients
Park Nicollet Clinic CurrentSince Sep 1, 2014 Accepting new patients
Group Health, Inc. CurrentSince May 1, 2016 Accepting new patients
Regions Hospital Past Accepting new patients

Locations

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

420 Delaware St SE
#276
Minneapolis, MN 55455
Phone (612) 624-0999

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

640 Jackson St
#11502B
Saint Paul, MN 55101
Phone (651) 254-3135

Interoperability endpoints

  • Direct secure messaging: dniccum109106@direct.healthpartners.com

Organizations & group practices 5

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 11

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": "1207267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1316110869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S",
            "address_2": "MS 21110Q",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554250341",
            "fax_number": "651-254-3048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 JACKSON ST",
            "address_2": "MS 11502B",
            "city": "ST. PAUL",
            "state": "MN",
            "postal_code": "551012502",
            "telephone_number": "651-254-3135",
            "fax_number": "651-254-3048"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "420 Delaware St SE",
            "address_2": "Pulmonary MMC: 276",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554550341",
            "country_code": "US",
            "telephone_number": "612-624-0999",
            "fax_number": "612-625-2174",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICCUM",
        "first_name": "DAVID",
        "middle_name": "ERNEST",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-04",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MN",
            "license": "56658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.