NPIMap

Individual provider Active NPI

Derek M Brickner, MD

  • Family Medicine Physician
  • Jamestown, ND
National Provider Identifier
1346405602
Registry record updated Mar 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
11895 Issued in ND
Practice address
300 2ND Ave NE
Jamestown, ND 58401-3373
Phone
(701) 251-6000
NPI assigned
Jul 25, 2008
Last updated
Mar 25, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2022

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 TEP5877 NE
Family Medicine Physician 207Q00000X 11895 ND Primary

Addresses

Primary practice location

300 2ND Ave NE
Jamestown, ND 58401-3373

Mailing address

300 2ND Ave NE
Jamestown, ND 58401-3373
Phone (701) 251-6000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dbrickner3255789@direct.sanfordhealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
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
I20111011000250 ND Practitioner - Family Practice 6002088325 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of North Dakota School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford Medical Center FargoGroup PAC ID 8426967803, 1,210 clinicians
Lutheran Charity AssociationGroup PAC ID 2264341031, 168 clinicians

Practice addresses (Care Compare)

1220 Sheyenne St
West Fargo, ND 58078-2637
Phone (701) 234-4445

2400 32ND Ave S
Fargo, ND 58103-5800
Phone (701) 234-2000

2422 20TH St SW
Jamestown, ND 58401-6201
Phone (701) 252-1050

300 2ND Ave NE
Jamestown, ND 58401-3373
Phone (701) 251-6000

520 Chautauqua Blvd
Valley City, ND 58072-3145
Phone (701) 845-6000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.78 of 100Reported as apm
Quality
80.38
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
82.73 of 100Reported as group
Quality
71.75
Promoting interoperability
100
Improvement activities
40
Cost
70.68

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy13
Upper gastrointestinal (GI) endoscopy for acid reflux11
Removal of skin lesions85
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11895NDMDFamily Medicine Physician
TEP5877NEMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center Fargo Family Medicine CurrentSince Jul 1, 2022 Accepting new patients
Sanford Medical Center Fargo CurrentSince Jul 1, 2022 Accepting new patients
Lutheran Charity Association CurrentSince May 1, 2024 Accepting new patients
Lutheran Charity Association CurrentSince May 1, 2024 Accepting new patients
Sisters of Mary of the Presentation Long Term Care Past Accepting new patients
Lutheran Charity Association Past Accepting new patients

Locations

2400 32nd Ave S
Fargo, ND 58103
Phone (701) 234-8800

2422 20th St SW
Jamestown, ND 58401
Phone (701) 252-1050

300 2nd Ave NE
Jamestown, ND 58401
Phone (701) 251-6000

1220 Sheyenne St
West Fargo, ND 58078
Phone (701) 234-4445

Interoperability endpoints

  • Direct secure messaging: dbrickner3255789@direct.sanfordhealth.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Eventide JamestownJamestown, ND, CCN 355078 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2024
Mar 27, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

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 12

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": "1216944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648166400000",
    "number": "1346405602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 2ND AVE NE",
            "city": "JAMESTOWN",
            "state": "ND",
            "postal_code": "584013373",
            "telephone_number": "701-251-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 2ND AVE NE",
            "city": "JAMESTOWN",
            "state": "ND",
            "postal_code": "584013373",
            "telephone_number": "701-251-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRICKNER",
        "first_name": "DEREK",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-25",
        "last_updated": "2022-03-25",
        "certification_date": "2022-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "TEP5877",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ND",
            "license": "11895",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dbrickner3255789@direct.sanfordhealth.org",
            "affiliation": "N",
            "address_1": "300 2nd Ave NE",
            "city": "Jamestown",
            "state": "ND",
            "country_code": "US",
            "postal_code": "584013373",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jamestown, ND

Sources for this page

Verify at the official NPI Registry.