NPIMap

Individual provider Active NPI

Jacqueline D Nelson, PA-C

  • Physician Assistant
  • Carrington, ND
National Provider Identifier
1750586772
Registry record updated Aug 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PAC0368 Issued in ND
Practice address
820 5TH St N
Carrington, ND 58421
Phone
(701) 652-2515
Fax
(701) 652-3595
NPI assigned
Jun 19, 2007
Last updated
Aug 1, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PAC0368 ND Primary
Medical Physician Assistant 363AM0700X PAC0368 ND

Addresses

Primary practice location

820 5TH St N
Carrington, ND 58421

Mailing address

820 5TH St N
PO Box 79
Carrington, ND 58421-1223
Phone (701) 652-2515

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
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
I20070731000372 ND Practitioner - Physician Assistant 2567568009 Reassigns benefits to 10 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cooperstown Medical CenterGroup PAC ID 5698687689, 13 clinicians
Carrington Health CenterGroup PAC ID 0547177552, shared by 4 NPIs, 12 clinicians

Practice addresses (Care Compare)

107 12TH St S
Cooperstown, ND 58425-4501
Phone (701) 786-1700

1200 Roberts Ave NE
Cooperstown, ND 58425-7101
Phone (701) 797-2128

820 N 5TH St
Carrington, ND 58421-1223
Phone (701) 652-2515

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PAC0368NDMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carrington Health Center CurrentSince Jan 1, 2025 Accepting new patients
Mercy Hospital CurrentSince Aug 14, 2019 Accepting new patients
Mercy Hospital of Valley City CurrentSince Jan 1, 2025 Accepting new patients
Carrington Health Center CurrentSince Jun 15, 2007 Accepting new patients
Carrington Health Center CurrentSince Jun 15, 2007 Accepting new patients
Lisbon Area Health Services CurrentSince Jan 1, 2025 Accepting new patients
Lisbon Area Health Services CurrentSince Mar 23, 2022 Accepting new patients
Garrison Memorial Hospital CurrentSince Jul 25, 2025 Accepting new patients
Mercy Hospital of Valley City CurrentSince Aug 14, 2019 Accepting new patients
Cooperstown Medical Center CurrentSince Dec 5, 2024 Accepting new patients
Lisbon Area Health Services Past Accepting new patients
Mercy Hospital of Devils Lake Past Accepting new patients
Cooperstown Medical Center Past Accepting new patients

Locations

3265 Solutions Ctr
Chicago, IL 60677

3276 Solutions Ctr
Chicago, IL 60677

7776 Solutions Ctr
Chicago, IL 60677

800 4th St N
Carrington, ND 58421
Phone (701) 652-3141

820 5th St N
Carrington, ND 58421
Phone (701) 399-0123

107 12th St S
Cooperstown, ND 58425
Phone (701) 786-1700

1200 Roberts Ave NE
Cooperstown, ND 58425
Phone (701) 797-2128

407 3rd Ave SE
Garrison, ND 58540
Phone (701) 463-2245

437 3rd Ave SE
Garrison, ND 58540
Phone (701) 463-2245

570 Chautauqua Blvd
Valley City, ND 58072
Phone (701) 845-0440

Interoperability endpoints

  • Direct secure messaging: afterhoursmedical.jacquelinenelson@154032.advancedmd-direct.com

Organizations & group practices 16

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.

View all 16

Hospital & facility affiliations 6

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": "1182211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533081600000",
    "number": "1750586772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 5TH ST N",
            "address_2": "PO BOX 79",
            "city": "CARRINGTON",
            "state": "ND",
            "postal_code": "584211223",
            "telephone_number": "701-652-2515",
            "fax_number": "701-652-3595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 5TH ST N",
            "city": "CARRINGTON",
            "state": "ND",
            "postal_code": "58421",
            "telephone_number": "701-652-2515",
            "fax_number": "701-652-3595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "JACQUELINE",
        "middle_name": "D",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-19",
        "last_updated": "2018-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ND",
            "license": "PAC0368",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ND",
            "license": "PAC0368",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrington, ND

Sources for this page

Verify at the official NPI Registry.