Active NPI
Justin Nielsen
- Certified Registered Nurse Anesthetist
- Idaho Falls, ID
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- AP60732499
- Practice address
- 2325 Coronado St
Idaho Falls, ID 83404-7407 - Phone
- (208) 557-2700
- NPI assigned
- Jan 23, 2017
- Last updated
- Sep 13, 2023
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN60182254 | WA | |
| Certified Registered Nurse Anesthetist | 367500000X | AP60732499 | WA | Primary |
Addresses
Primary practice location
2325 Coronado St
Idaho Falls, ID 83404-7407
Mailing address
2325 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 557-2700
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jnielsen800460@wm.providencedirect.org | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID, IA
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1000 4TH St SW
Mason City, IA 50401-2800
2325 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 557-2700
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN60182254 | WA | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Intermountain Anesthesia, PA | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| Mountain View Hospital LLC | Current | Accepting new patients | |
| North Iowa Mercy Clinics | Current | Accepting new patients | |
| North Iowa Mercy Clinics | Current | Accepting new patients |
Locations
1000 4th St SW
Mason City, IA 50401
Phone (641) 424-6704
2325 Coronado St
Idaho Falls, ID 83404
Phone (208) 528-7686
3100 Channing Way
Idaho Falls, ID 83404
Phone (208) 227-2100
Interoperability endpoints
- jnielsen800460@wm.providencedirect.org
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.
-
- General Acute Care Hospital
- Idaho Falls, ID
- NPI 1669462362
-
dba MercyOne North Iowa Anesthesia Professional Services
- Anesthesiology Physician
- Mason City, IA
- NPI 1780278242
-
- Anesthesiology Physician
- Idaho Falls, ID
- NPI 1558304329
Nurse Anesthetist, Certified Registered
-
dba MercyOne North Iowa Family and Sports Medicine
- Sports Medicine (Family Medicine) Physician
- Mason City, IA
- NPI 1982300349
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Idaho Falls, ID
- NPI 1114481447
-
- General Acute Care Hospital
- Idaho Falls, ID
- NPI 1669462362
-
dba Mercy Medical Center-North Iowa
- Rural Acute Care Hospital
- Mason City, IA
- NPI 1467537886
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1485129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694563200000",
"number": "1740727221",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2325 CORONADO ST",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834047407",
"telephone_number": "208-557-2700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2325 CORONADO ST",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834047407",
"telephone_number": "208-557-2700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIELSEN",
"first_name": "JUSTIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-01-23",
"last_updated": "2023-09-13",
"certification_date": "2023-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "WA",
"license": "RN60182254",
"primary": false
},
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "WA",
"license": "AP60732499",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "jnielsen800460@wm.providencedirect.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "101 W 8th Ave",
"city": "Spokane",
"state": "WA",
"country_code": "US",
"postal_code": "992042307",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Idaho Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.