Jaycob Nietfeld, APRN
Individual provider Active NPI Family Nurse Practitioner · Long Prairie, MN
NPI 1417544479 · NPPES record last updated Dec 24, 2020
Key facts
- NPI
- 1417544479
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 7821 (MN)
- Practice address
- 50 Centracare Dr
Long Prairie, MN 56347-2100 - Phone
- (320) 732-2131
- NPI assigned
- Dec 24, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 21
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Centracare Clinic
Centracare Health System - Long Prairie
Practice addresses (Care Compare)
2000 23Rd St S
Sartell, MN 56377-4765
Phone (320) 202-8949
50 Centracare Dr
Long Prairie, MN 56347-2100
Phone (320) 732-2141
Hospital & facility affiliations
- Centracare - Long Prairie Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- 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 |
|---|---|---|---|---|
| I20210205000004 | MN | Practitioner - Nurse Practitioner | 6800200601 | Reassigns benefits to 7 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 78211 | MN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Centracare Clinic | Current |
Accepting new patients | |
| Centracare Health-Paynesville LLC | Current |
Accepting new patients | |
| Centracare Clinic | Current | Accepting new patients | |
| Centracare Health-Paynesville LLC | Current |
Accepting new patients | |
| Centracare Clinic | Current |
Accepting new patients | |
| Centracare Health System - Long Prairie | Current |
Accepting new patients | |
| Centracare Clinic | Past | Accepting new patients | |
| Centracare Clinic | Past | Accepting new patients |
Locations
50 Centracare Dr
Long Prairie, MN 56347
Phone (320) 732-2131
525 Main St W
Melrose, MN 56352
Phone (320) 256-4228
200 W 1st St
Paynesville, MN 56362
Phone (320) 243-3767
1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342
1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422
Interoperability endpoints
- jnietfeld561776@direct.centracare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 78211 | MN | |
| Family Nurse Practitioner | 363LF0000X | 7821 | MN | Yes |
Addresses
Primary practice location
50 Centracare Dr
Long Prairie, MN 56347-2100
Mailing address
50 Centracare Dr
Long Prairie, MN 56347-2100
Phone (320) 732-2131
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jaycob.nietfeld@centracare.com |
Other providers in Long Prairie, MN
- Minnesota Eyecare Network, Inc
- Minnesota Eyecare Network, Inc.
- Mark William Mohr
- John P Nei
- Neighborhood Counseling Center of Wadena, Inc
- Jennifer Oldenburg Sr.
- Christine M. Olson
- Pathways Counseling PLLC
- Patti Venekamp Counseling Services, P.C.
- Camilla Peterson-Devries
All providers in Long Prairie, MN · Family Nurse Practitioner in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 24, 2020. 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.