Active NPI
Kara Denae Eickman, M.D.
- Neurology Physician
- Fargo, ND
National Provider Identifier
1710160379
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 11645
- Practice address
- 2301 25TH St S
Fargo, ND 58103-6104 - Phone
- (701) 234-7400
- NPI assigned
- Dec 6, 2007
- Last updated
- May 22, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | NU | ||
| Neurology Physician | 2084N0400X | 11645 | ND | Primary |
Addresses
Primary practice location
2301 25TH St S
Fargo, ND 58103-6104
Mailing address
PO Box 5074
Sioux Falls, SD 57117-5074
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 15364 | Medicaid | ND | |
| 1710160379 | Medicaid | MN |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | keickman1841242@direct.sanfordhealth.org |
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 |
|---|---|---|---|
| 11645 | ND | MD | Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196899200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684713600000",
"number": "1710160379",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5074",
"city": "SIOUX FALLS",
"state": "SD",
"postal_code": "571175074"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2301 25TH ST S",
"city": "FARGO",
"state": "ND",
"postal_code": "581036104",
"telephone_number": "701-234-7400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EICKMAN",
"first_name": "KARA",
"middle_name": "DENAE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-12-06",
"last_updated": "2023-05-22",
"certification_date": "2023-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "ND",
"license": "11645",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "15364",
"state": "ND"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1710160379",
"state": "MN"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "keickman1841242@direct.sanfordhealth.org",
"affiliation": "N",
"address_1": "700 1st Ave S",
"city": "Fargo",
"state": "ND",
"country_code": "US",
"postal_code": "581031802",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.