NPIMap

Individual provider Active NPI

Nikki L Deboer, CRNP

  • Family Nurse Practitioner
  • Waynesboro, PA
National Provider Identifier
1356878540
Registry record updated Jun 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R218514 Issued in MD
Practice address
1051 E Main St
Waynesboro, PA 17268-2318
Phone
(717) 762-9118
NPI assigned
May 18, 2017
Last updated
Jun 28, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R218514 MD Primary
Family Nurse Practitioner 363LF0000X F05170310 MD

Addresses

Primary practice location

1051 E Main St
Waynesboro, PA 17268-2318

Mailing address

1051 E Main St Ste 1
Waynesboro, PA 17268-2318
Phone (717) 762-9118

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Practice@waynesborofma.medentdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20200609000579 PA Practitioner - Nurse Practitioner 5193073666 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Waynesboro Family Medical Associates, LLPGroup PAC ID 8325934508, 5 clinicians

Practice addresses (Care Compare)

1051 E Main St
Suite 1
Waynesboro, PA 17268-2318
Phone (717) 762-9118

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
F05170310MDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Waynesboro Family Medical Associates, LLP CurrentSince Jun 1, 2020 Accepting new patients
Maryland Medical Services LLC PastSince Nov 3, 2012 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

1051 E Main St
Ste 1
Waynesboro, PA 17268
Phone (717) 762-9118

Interoperability endpoints

  • Direct secure messaging: practice@waynesborofma.medentdirect.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 10

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": "1495065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624838400000",
    "number": "1356878540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1051 E MAIN ST STE 1",
            "city": "WAYNESBORO",
            "state": "PA",
            "postal_code": "172682318",
            "telephone_number": "717-762-9118",
            "fax_number": "717-762-2860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1051 E MAIN ST",
            "city": "WAYNESBORO",
            "state": "PA",
            "postal_code": "172682318",
            "telephone_number": "717-762-9118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEBOER",
        "first_name": "NIKKI",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-18",
        "last_updated": "2021-06-28",
        "certification_date": "2021-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R218514",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "F05170310",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Practice@waynesborofma.medentdirect.com",
            "affiliation": "N",
            "address_1": "1051 E Main St",
            "city": "Waynesboro",
            "state": "PA",
            "country_code": "US",
            "postal_code": "172682318",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Waynesboro, PA

Sources for this page

Verify at the official NPI Registry.