NPIMap

Individual provider Active NPI

Jennifer Nicole Pickett, PA-C

  • Physician Assistant
  • Saint Cloud, MN
National Provider Identifier
1508112178
Registry record updated Jan 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
11242 Issued in MN
Practice address
Centracare Clinic Adult and Pediatric Urology
2351 Connecticut Avenue South #200
St Cloud, MN 56303-2477
Phone
(320) 259-1411
Fax
(320) 259-8967
NPI assigned
Aug 1, 2012
Last updated
Jan 25, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 11242 MN Primary

Addresses

Primary practice location

Centracare Clinic Adult and Pediatric Urology
2351 Connecticut Avenue South #200
St Cloud, MN 56303-2477

Mailing address

Centracare Clinic Adult and Pediatric Urology
2351 Connecticut Avenue South #200
St Cloud, MN 56303-2477
Phone (320) 259-1411

Other identifiers 1

IdentifierTypeStateIssuer
ENROLLEDMedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20130320000547 MN Practitioner - Physician Assistant 8820233943 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians
Centracare Health System - MelroseGroup PAC ID 1658270368, shared by 3 NPIs, 38 clinicians

Practice addresses (Care Compare)

1200 6TH Ave N
Saint Cloud, MN 56303-2735

1200 6TH N Ave
Saint Cloud, MN 56303-2735
Phone (320) 252-5131

1406 6TH Ave N
St Cloud, MN 56303-1901

1406 6TH Ave No
St Cloud, MN 56303-1901

1900 Centracare Cir
Saint Cloud, MN 56303-5000

525 Main St W
Melrose, MN 56352-1043
Phone (320) 256-4231

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic CurrentSince Sep 2, 2018 Accepting new patients
Centracare Clinic CurrentSince Sep 2, 2018 Accepting new patients
Centracare Clinic Southwest LLC CurrentSince Apr 6, 2022 Accepting new patients
Centracare Clinic Past Accepting new patients
Mayo Clinic Past Accepting new patients

Locations

600 Peterson Pkwy
New London, MN 56273
Phone (320) 354-2222

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

2351 Connecticut Ave S
Ste 200
Sartell, MN 56377
Phone (320) 203-6906

Interoperability endpoints

  • Direct secure messaging: jirlbeck410322@direct.centracare.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1343779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611532800000",
    "number": "1508112178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "CENTRACARE CLINIC ADULT AND PEDIATRIC UROLOGY",
            "address_2": "2351 CONNECTICUT AVENUE SOUTH #200",
            "city": "ST CLOUD",
            "state": "MN",
            "postal_code": "563032477",
            "telephone_number": "320-259-1411",
            "fax_number": "320-259-8967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CENTRACARE CLINIC ADULT AND PEDIATRIC UROLOGY",
            "address_2": "2351 CONNECTICUT AVENUE SOUTH #200",
            "city": "ST CLOUD",
            "state": "MN",
            "postal_code": "563032477",
            "telephone_number": "320-259-1411",
            "fax_number": "320-259-8967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PICKETT",
        "first_name": "JENNIFER",
        "middle_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-01",
        "last_updated": "2021-01-25",
        "certification_date": "2021-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "11242",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.