Jonathan Albert Sticca, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

15165 Issued in ND

Practice address

5225 23Rd Ave S
Fargo, ND 58104-7927

Phone

(701) 417-1333

NPI assigned

Jun 20, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in ND

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Altru Health System

  • Clinic/Center
  • Grand Forks, ND
  • NPI 1043309552

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1434758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691107200000",
    "number": "1669854196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 NORTH COLUMBIA ROAD",
            "address_2": "RM E270 STOP 9037",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582029037",
            "telephone_number": "701-777-2636",
            "fax_number": "701-777-3609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5225 23RD AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581047927",
            "telephone_number": "701-417-1333"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3000 32nd Ave S",
            "address_purpose": "LOCATION",
            "city": "Fargo",
            "state": "ND",
            "postal_code": "581036132",
            "country_code": "US",
            "telephone_number": "701-364-8900",
            "fax_number": "701-364-4590",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2101 Elm St N",
            "address_purpose": "LOCATION",
            "city": "Fargo",
            "state": "ND",
            "postal_code": "581022417",
            "country_code": "US",
            "telephone_number": "701-232-3241",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "801 Broadway N",
            "address_purpose": "LOCATION",
            "city": "Fargo",
            "state": "ND",
            "postal_code": "581023641",
            "country_code": "US",
            "telephone_number": "701-234-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 S Columbia Rd",
            "address_purpose": "LOCATION",
            "city": "Grand Forks",
            "state": "ND",
            "postal_code": "582014032",
            "country_code": "US",
            "telephone_number": "701-780-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STICCA",
        "first_name": "JONATHAN",
        "middle_name": "ALBERT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-20",
        "last_updated": "2023-08-04",
        "certification_date": "2023-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ND",
            "license": "15165",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "LL38351",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "46141",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "ND",
            "license": "15165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bob Clifford Stewart, LCSW
• Denise Stewart, FNP
• Marshaun Stewart
• Adam F Stibbe, M.D.
• Anna L Stibral, DNP, APRN, CNP
• Justin Stich
• Sherrey L Stich, SLP
• Tracy Stickel
• Tara Stickler, RN
• Ashley Lynn Stielow, LPCC

• Surgery Physician in Fargo, ND
• Providers in Fargo, ND by specialty
• Surgery Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.