NPIMap

Individual provider Active NPI

Nicole Marie Busch, FNP-BC

  • Family Nurse Practitioner
  • Littlefork, MN
National Provider Identifier
1669812459
Registry record updated Oct 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
CNP 2635 Issued in MN
Practice address
912 Main St
Littlefork, MN 56653-9357
Phone
(218) 278-6634
Fax
(218) 278-6637
NPI assigned
Jun 26, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X CNP 2635 MN Primary

Addresses

Primary practice location

912 Main St
Littlefork, MN 56653-9357

Mailing address

912 Main St
Littlefork, MN 56653-9357
Phone (218) 278-6634

Other identifiers 2

IdentifierTypeStateIssuer
R143402-8OtherMNMINNESOTA RN LICENSE NUMBER
CNP 2635OtherMNAPRN LICENSE NUMBER

Other names 1

  • Nicole Marie Ward Former name

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
I20140701000531 MN Practitioner - Nurse Practitioner 3476778721 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of North Dakota School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
International Falls Memorial Hospital Association 18 clinicians

Practice addresses (Care Compare)

1400 Hwy 71
International Falls, MN 56649-2154
Phone (218) 283-4481

912 Main St
Littlefork, MN 56653-9378
Phone (218) 278-6634

Hospital & facility affiliations

  • Sanford Bemidji Hospice Hospice, Bemidji, MN, CCN 241511
  • Rainy Lake Medical Center Hospital, International Falls, MN, CCN 241322
  • Sanford Bemidji Medical Center Hospital, Bemidji, MN, CCN 240100

Merit-based Incentive Payment System (MIPS)

Final score
92.39 of 100Reported as group
Quality
86.16
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CNP 2635MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
International Falls Memorial Hospital Association CurrentSince Feb 1, 2016 Accepting new patients
International Falls Memorial Hospital Association CurrentSince Feb 1, 2016 Accepting new patients
International Falls Memorial Hospital Association Past Accepting new patients
Koochiching Health Services Past Accepting new patients
Essentia Health Virginia, LLC Past Accepting new patients

Locations

1400 Highway 71
Intl Falls, MN 56649
Phone (218) 283-4481

912 Main St
Littlefork, MN 56653
Phone (218) 278-6634

Organizations & group practices 6

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 4

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": "1372204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444089600000",
    "number": "1669812459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "912 MAIN ST",
            "city": "LITTLEFORK",
            "state": "MN",
            "postal_code": "566539357",
            "telephone_number": "218-278-6634",
            "fax_number": "218-278-6637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "912 MAIN ST",
            "city": "LITTLEFORK",
            "state": "MN",
            "postal_code": "566539357",
            "telephone_number": "218-278-6634",
            "fax_number": "218-278-6637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSCH",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-26",
        "last_updated": "2015-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "CNP 2635",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MINNESOTA RN LICENSE NUMBER",
            "identifier": "R143402-8",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APRN LICENSE NUMBER",
            "identifier": "CNP 2635",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "WARD",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Littlefork, MN

Sources for this page

Verify at the official NPI Registry.