Individual provider Active NPI

Joel Dennis Tuckett

  • Certified Registered Nurse Anesthetist
  • Hibbing, MN
National Provider Identifier
1487096434
Registry record updated Dec 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
93089 Issued in UT
Practice address
1932 10TH Ave E
Hibbing, MN 55746-1614
Phone
(208) 757-3937
NPI assigned
Jul 18, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 9317826 FL
Certified Registered Nurse Anesthetist 367500000X 93089 UT Primary
Registered Nurse 163W00000X 215610-1 MN

Addresses

Primary practice location

1932 10TH Ave E
Hibbing, MN 55746-1614

Mailing address

1932 10TH Ave E
Hibbing, MN 55746-1614
Phone (208) 757-3937

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180911000326 WY Practitioner - Certified Registered Nurse Anesthetist (Crna) 4486898004 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Campbell County Hospital DistrictGroup PAC ID 2860392529, 128 clinicians
Wyoming Medical Associates LLCGroup PAC ID 2769802552, 12 clinicians

Practice addresses (Care Compare)

501 S Burma Ave
Gillette, WY 82716-3426
Phone (307) 688-1000

51 Town Ctr Dr
Suite 120
Gillette, WY 82718-5521
Phone (307) 682-9962

Hospital & facility affiliations

  • Campbell County Health Hospital, Gillette, WY, CCN 530002

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1055MNMDProfessional Counselor
9317826FLMDRegistered Nurse
215610-1MNMDRegistered Nurse
93089UTMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Campbell County Hospital District Current Accepting new patients
Campbell County Hospital District CurrentSince Aug 20, 2018 Accepting new patients
Campbell County Hospital District Current Accepting new patients
Campbell County Hospital District CurrentSince Aug 20, 2018 Accepting new patients
Campbell County Hospital District Current Accepting new patients
Cloud Peak Anesthesia, LLC Nurse Anesthetist, Certified Registered CurrentSince Mar 1, 2020 Accepting new patients

Locations

1307 W 3rd St
Ste B
Gillette, WY 82716
Phone (307) 686-8283

501 S Burma Ave
Gillette, WY 82716
Phone (307) 682-8811

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1374105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449705600000",
    "number": "1487096434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1932 10TH AVE E",
            "city": "HIBBING",
            "state": "MN",
            "postal_code": "557461614",
            "telephone_number": "208-757-3937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1932 10TH AVE E",
            "city": "HIBBING",
            "state": "MN",
            "postal_code": "557461614",
            "telephone_number": "208-757-3937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKETT",
        "first_name": "JOEL",
        "middle_name": "DENNIS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-18",
        "last_updated": "2015-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "FL",
            "license": "9317826",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "UT",
            "license": "93089",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "215610-1",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hibbing, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.