Nicole Gibson, DNP
Individual provider Active NPI Nurse Practitioner · Sioux Falls, SD
NPI 1366480139 · NPPES record last updated Feb 13, 2019
Key facts
- NPI
- 1366480139
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- CP000446 (SD)
- Practice address
- 4520 W 69TH St
Sioux Falls, SD 57108-8148 - Phone
- (605) 977-5000
- Fax
- (605) 977-5377
- NPI assigned
- Jun 3, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 28
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Heart Hospital of South Dakota LLC
Practice addresses (Care Compare)
4500 W 69TH St
Sioux Falls, SD 57108-8148
4520 W 69TH St
Sioux Falls, SD 57108-8148
Phone (605) 977-5000
Hospital & facility affiliations
- Avera Heart Hospital of South Dakota
- Avera McKennan Hospital & University Health Center
- Lakes Regional Healthcare
- Sioux Center Health
- Pipestone County Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SD
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051011000326 | SD | Practitioner - Nurse Practitioner | 2062437825 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CP000446 | SD | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Heart Hospital of South Dakota LLC | Current |
Accepting new patients | |
| Avera McKennan | Past | Accepting new patients | |
| Heart Hospital of South Dakota LLC | Past | Accepting new patients |
Locations
4500 W 69th St
Sioux Falls, SD 57108
Phone (605) 977-7000
4520 W 69th St
Sioux Falls, SD 57108
Phone (605) 977-5000
Interoperability endpoints
- nicole.gibson@avera.sdhealthlink.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | CP000446 | SD | Yes |
Addresses
Primary practice location
4520 W 69TH St
Sioux Falls, SD 57108-8148
Mailing address
PO Box 5009
Sioux Falls, SD 57117-5009
Phone (605) 977-5000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01-22224 | Other | MEDICA | |
| 4994462 | Other | SD | SD BCBS |
| 9237752 | Other | SD | DAKOTACARE |
| 435L7GI | Other | MN | MN BLUE SHIELD |
| 6828020 | Medicaid | SD | |
| 931451047321 | Other | PREFERRED ONE |
Other providers in Sioux Falls, SD
- Bhargavi Ghanta
- Taylor Rose Giacopelli
- Melanie Gibbons
- Abigail Gibbs
- Chelsie Gibson
- Scott Wesley Gibson
- Tiffany Giese
- Alexis Giff
- Gift Home Health Care LLC
- Ethan Gilbert
All providers in Sioux Falls, SD · Nurse Practitioner in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 13, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.