Mark Ryan Nikkel, DO

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

36100980 Issued in IL

Practice address

955 S Bailey Ave
South Haven, MI 49090-6743

Phone

(269) 637-5271

Fax

(269) 639-2818

NPI assigned

Sep 27, 2005

Last updated

Nov 27, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Orthopedic Surgery

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bronson South Haven HospitalGroup PAC ID 6204724834, 38 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bronson South Haven Hospital Hospital, South Haven, MI, CCN 230085
• Bronson Lakeview Hospital Hospital, Paw Paw, MI, CCN 231332
• Bronson Methodist Hospital Hospital, Kalamazoo, MI, CCN 230017
• Corewell Health Watervliet Hospital Hospital, Watervliet, MI, CCN 230078

Merit-based Incentive Payment System (MIPS)

Final score

81.25 of 100Reported as group

Quality

96.84

Promoting interoperability

100

Improvement activities

40

Cost

40.67

Merit-based Incentive Payment System (MIPS)

Final score

93.89 of 100Reported as group

Quality

95.63

Promoting interoperability

100

Improvement activities

40

Cost

84

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: direct@direct.bronsonhg.org
• Direct secure messaging: mnikkel55680@direct.bronsonhg.org

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.

• Bronson South Haven Hospital

  dba Bronson Medical Group

  • Family Medicine Physician
  • South Haven, MI
  • NPI 1174749170
  Medicare reassignment Care Compare group NPD
• Bronson Lakeview Hospital

  dba Bronson Medical Group

  • Internal Medicine Physician
  • Paw Paw, MI
  • NPI 1235131137
  Medicare reassignment NPD
• Bronson Lakeview Hospital

  • Critical Access Hospital
  • Paw Paw, MI
  • NPI 1962508259
  Medicare reassignment NPD
• Bronson Lakeview Hospital

  dba Bronson LakeView Family Care-Blue Star

  • Rural Health Clinic/Center
  • South Haven, MI
  • NPI 1801538871
  NPD
• Bronson South Haven Hospital

  • General Acute Care Hospital
  • South Haven, MI
  • NPI 1346275856
  NPD

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

• Bronson Lakeview Hospital

  • Critical Access Hospital
  • Paw Paw, MI
  • NPI 1962508259
  Care Compare affiliation
• Bronson Methodist Hospital

  • General Acute Care Hospital
  • Kalamazoo, MI
  • NPI 1831116441
  Care Compare affiliation
• Bronson South Haven Hospital

  • General Acute Care Hospital
  • South Haven, MI
  • NPI 1346275856
  Care Compare affiliation
• Lakeland Community Hospital Watervliet

  dba Corewell Health Watervliet Hospital

  • General Acute Care Hospital
  • Watervliet, MI
  • NPI 1700994845
  Care Compare affiliation

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

{
    "created_epoch": "1127779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1699762336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "955 S BAILEY AVE",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490906743",
            "telephone_number": "269-637-5271",
            "fax_number": "269-639-2818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 S BAILEY AVE",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490906743",
            "telephone_number": "269-637-5271",
            "fax_number": "269-639-2818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIKKEL",
        "first_name": "MARK",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-27",
        "last_updated": "2023-11-27",
        "certification_date": "2020-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "IL",
            "license": "36100980",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036100980",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI NUMBER",
            "identifier": "1023138633",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "31622992",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "036-100980",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.bronsonhg.org",
            "affiliation": "Y",
            "endpointDescription": "Bronson Healthcare Group Direct address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Continuity of Care Document",
            "address_1": "601 John St",
            "city": "Kalamazoo",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490075341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Orthopaedic Surgery Physician in South Haven, MI
• Providers in South Haven, MI by specialty
• Orthopaedic Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.