NPIMap

Individual provider Active NPI

Nicole Elisabeth Johnson, CNP

  • Nurse Practitioner
  • Rapid City, SD
National Provider Identifier
1639485923
Registry record updated Sep 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
CP000607 Issued in SD
Practice address
2820 Mount Rushmore Rd
Rapid City, SD 57701-5462
Phone
(605) 342-3280
NPI assigned
Aug 24, 2010
Last updated
Sep 16, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X CP000607 SD Primary

Addresses

Primary practice location

2820 Mount Rushmore Rd
Rapid City, SD 57701-5462

Mailing address

2820 Mount Rushmore Rd
Rapid City, SD 57701-5462
Phone (605) 342-9280

Other identifiers 1

IdentifierTypeStateIssuer
CP000607OtherSDLICENSE

Other names 1

  • Nicole Elisabeth Graves Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
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
I20101019000219 SD Practitioner - Nurse Practitioner 3779776117 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

353 Fairmont Blvd
Rapid City, SD 57701-7375
Phone (605) 755-8109

640 Flormann St
Rapid City, SD 57701-4679
Phone (605) 755-3300

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Monument Health Rapid City Hospital Inc CurrentSince Aug 2, 2010 Accepting new patients
Monument Health Rapid City Hospital, Inc. CurrentSince Aug 2, 2010 Accepting new patients
Monument Health Rapid City Hospital, Inc Current Accepting new patients
Regional Health Physicians Inc Past Accepting new patients

Locations

353 Fairmont Blvd
Rapid City, SD 57701
Phone (605) 719-1000

Interoperability endpoints

  • Direct secure messaging: njohnson.12400@regionalhealth.sdhealthlink.net

Organizations & group practices 4

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 24

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1282608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316131200000",
    "number": "1639485923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2820 MOUNT RUSHMORE RD",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577015462",
            "telephone_number": "605-342-9280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2820 MOUNT RUSHMORE RD",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577015462",
            "telephone_number": "605-342-3280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "NICOLE",
        "middle_name": "ELISABETH",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-24",
        "last_updated": "2011-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SD",
            "license": "CP000607",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "CP000607",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "GRAVES",
            "middle_name": "ELISABETH",
            "credential": "CNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Rapid City, SD

Sources for this page

Verify at the official NPI Registry.