Active NPI
Jacalyn Dicello, M.D.
- Gynecology Physician
- Burnsville, MN
National Provider Identifier
1518989656
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gynecology Physician
- License
- 23731
- Practice address
- 14000 Nicollet Ave
Suite 100
Burnsville, MN 55337-5790 - Phone
- (952) 428-0200
- NPI assigned
- Jul 25, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | 23731 | MN | Primary |
Addresses
Primary practice location
14000 Nicollet Ave
Suite 100
Burnsville, MN 55337-5790
Mailing address
2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 262-5000
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0702123 | Other | MN | MEDICA |
| 0371001 | Other | MN | PREFERRED ONE |
| 087288100 | Medicaid | MN | |
| HP10327 | Other | MN | HEALTH PARTNERS |
| 57F36DI | Other | MN | BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23731 | MN | MD | Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321833600000",
"number": "1518989656",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2925 CHICAGO AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554071321",
"telephone_number": "612-262-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14000 NICOLLET AVE",
"address_2": "SUITE 100",
"city": "BURNSVILLE",
"state": "MN",
"postal_code": "553375790",
"telephone_number": "952-428-0200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICELLO",
"first_name": "JACALYN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-25",
"last_updated": "2011-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "207VG0400X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": "MN",
"license": "23731",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "0702123",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "0371001",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "087288100",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "HP10327",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "57F36DI",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Burnsville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.