NPIMap

Individual provider Active NPI

Dustin Duane Nickerson, FNP-C

  • Nurse Practitioner
  • Phoenix, AZ
National Provider Identifier
1760988224
Registry record updated Sep 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP11349 Issued in AZ
Practice address
2610 N 3Rd St
Phoenix, AZ 85004-1102
Phone
(480) 610-6100
Fax
(480) 610-6189
NPI assigned
Apr 3, 2018
Last updated
Sep 26, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 26, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP11349 AZ Primary
Critical Care Medicine Registered Nurse 163WC0200X RN AZ

Addresses

Primary practice location

2610 N 3Rd St
Phoenix, AZ 85004-1102

Mailing address

2149 E Warner Rd Ste 102
Tempe, AZ 85284-3495
Phone (480) 610-6100

Other practice location 1

21367 E Via Del Rancho
Queen Creek, AZ 85142-5260
Phone (480) 329-0706

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20181107002975 AZ Practitioner - Nurse Practitioner 2567716640 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southwest Kidney Institute PLCGroup PAC ID 8224930987, 100 clinicians

Practice addresses (Care Compare)

2610 N 3Rd St
Phoenix, AZ 85004-1102
Phone (480) 610-6100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.02 of 100Reported as group
Quality
69.14
Promoting interoperability
100
Improvement activities
40
Cost
77.59

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RNAZMDCritical Care Medicine Registered Nurse
AP11349AZMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Kidney Institute, PLC CurrentSince Oct 1, 2018 Accepting new patients
Southwest Kidney Institute, PLC CurrentSince Oct 1, 2018 Accepting new patients

Locations

301 S Power Rd
Ste 103
Mesa, AZ 85206
Phone (480) 325-7535

2610 N 3rd St
Phoenix, AZ 85004
Phone (602) 264-3541

9305 W Thomas Rd
Ste 255
Phoenix, AZ 85037
Phone (623) 247-9235

Organizations & group practices 2

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1522713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537920000000",
    "number": "1760988224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2149 E WARNER RD STE 102",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852843495",
            "telephone_number": "480-610-6100",
            "fax_number": "480-610-6189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2610 N 3RD ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850041102",
            "telephone_number": "480-610-6100",
            "fax_number": "480-610-6189"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21367 E Via Del Rancho",
            "address_purpose": "LOCATION",
            "city": "Queen Creek",
            "state": "AZ",
            "postal_code": "851425260",
            "country_code": "US",
            "telephone_number": "480-329-0706",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICKERSON",
        "first_name": "DUSTIN",
        "middle_name": "DUANE",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-03",
        "last_updated": "2018-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AZ",
            "license": "AP11349",
            "primary": true
        },
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "AZ",
            "license": "RN",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.