NPIMap

Individual provider Active NPI

Amanda J Dircks, NP

  • Family Nurse Practitioner
  • Saint Joseph, MN
National Provider Identifier
1326657255
Registry record updated Feb 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
7608 Issued in MN
Practice address
1360 Elm St E
Saint Joseph, MN 56374-4694
Phone
(203) 363-7765
NPI assigned
Jul 27, 2020
Last updated
Feb 26, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 195472-8 MN
Family Nurse Practitioner 363LF0000X 7608 MN Primary

Addresses

Primary practice location

1360 Elm St E
Saint Joseph, MN 56374-4694

Mailing address

1360 Elm St E
Saint Joseph, MN 56374-4694

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address amanda.dircks@centracare.com

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
I20210412002391 MN Practitioner - Nurse Practitioner 7618385634 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

1360 Elm St E
Centracare Clinic St Joseph
St Joseph, MN 56374-4694
Phone (320) 363-7765

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
195472-8MNMDRegistered Nurse
7608MNMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic Current Accepting new patients
Centracare Clinic CurrentSince Mar 1, 2021 Accepting new patients
Centracare Clinic CurrentSince Mar 1, 2021 Accepting new patients

Locations

715 1st St N
Cold Spring, MN 56320
Phone (320) 685-3693

1406 6th Ave N
Saint Cloud, MN 56303
Phone (320) 255-5657

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

1360 Elm St E
Saint Joseph, MN 56374
Phone (320) 363-1745

Interoperability endpoints

  • Direct secure messaging: adircks572975@direct.centracare.com
  • Direct secure messaging: amanda.dircks@centracare.com

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

Hospital & facility affiliations 7

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": "1595808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614297600000",
    "number": "1326657255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1360 ELM ST E",
            "city": "SAINT JOSEPH",
            "state": "MN",
            "postal_code": "563744694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1360 ELM ST E",
            "city": "SAINT JOSEPH",
            "state": "MN",
            "postal_code": "563744694",
            "telephone_number": "203-363-7765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIRCKS",
        "first_name": "AMANDA",
        "middle_name": "J",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-27",
        "last_updated": "2021-02-26",
        "certification_date": "2021-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "195472-8",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "7608",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amanda.dircks@centracare.com",
            "affiliation": "N",
            "address_1": "1406 6th Ave N",
            "city": "Saint Cloud",
            "state": "MN",
            "country_code": "US",
            "postal_code": "563031900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Joseph, MN

Sources for this page

Verify at the official NPI Registry.