NPIMap

Individual provider Active NPI

Danielle Wallinga, P.A.

  • Medical Physician Assistant
  • Niobrara, NE
National Provider Identifier
1750474755
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
908 Issued in NE
Practice address
25410 Park Ave
Apartment E
Niobrara, NE 68760-7044
Phone
(402) 857-3398
Fax
(402) 857-3315
NPI assigned
Oct 2, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 908 NE Primary

Addresses

Primary practice location

25410 Park Ave
Apartment E
Niobrara, NE 68760-7044

Mailing address

25410 Park Ave
Apartment E
Niobrara, NE 68760-7044
Phone (402) 857-3398

Other identifiers 6

IdentifierTypeStateIssuer
10025001900MedicaidNE
9955OtherNEMIDLANDS CHOICE
5300850OtherSDMEDICAID
9210187OtherNEDAKOTACARE
30387OtherNEBLUE SHIELD
5300850MedicaidSD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
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
I20100630000832 NE Practitioner - Physician Assistant 6608907902 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sacred Heart Health ServicesGroup PAC ID 6103729066, 151 clinicians

Practice addresses (Care Compare)

25410 Park Ave
Apt E
Niobrara, NE 68760-7044
Phone (402) 857-3398

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sacred Heart Health Services CurrentSince Mar 8, 2014 Accepting new patients
Sacred Heart Health Services CurrentSince Mar 8, 2014 Accepting new patients
Sacred Heart Health Services Past Accepting new patients

Locations

1104 W 8th St
Yankton, SD 57078
Phone (605) 665-7841

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.

Hospital & facility affiliations 8

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": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1750474755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25410 PARK AVE",
            "address_2": "APARTMENT E",
            "city": "NIOBRARA",
            "state": "NE",
            "postal_code": "687607044",
            "telephone_number": "402-857-3398",
            "fax_number": "402-857-3315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25410 PARK AVE",
            "address_2": "APARTMENT E",
            "city": "NIOBRARA",
            "state": "NE",
            "postal_code": "687607044",
            "telephone_number": "402-857-3398",
            "fax_number": "402-857-3315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLINGA",
        "first_name": "DANIELLE",
        "name_prefix": "Mrs.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NE",
            "license": "908",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025001900",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIDLANDS CHOICE",
            "identifier": "9955",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "5300850",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAKOTACARE",
            "identifier": "9210187",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "30387",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5300850",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Niobrara, NE

Sources for this page

Verify at the official NPI Registry.