NPIMap

Individual provider Active NPI

Nicholas Dueck, M.D.

  • Student in an Organized Health Care Education/Training Program
  • Port Jefferson, NY
National Provider Identifier
1811429681
Registry record updated Mar 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
75 N Country Rd
Port Jefferson, NY 11777-2119
Phone
(631) 686-2517
NPI assigned
Mar 31, 2017
Last updated
Mar 31, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

75 N Country Rd
Port Jefferson, NY 11777-2119

Mailing address

2465 S 3Rd Street PLZ
Omaha, NE 68108-1707
Phone (253) 740-0951

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, ID2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230612001975 OR Practitioner - Diagnostic Radiology 3971960642 Reassigns benefits to 1 organization
I20230612002264 ID Practitioner - Diagnostic Radiology 3971960642 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Creighton University School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gem State Radiology LLPGroup PAC ID 9335044833, 60 clinicians

Practice addresses (Care Compare)

1055 N Curtis Rd
Boise, ID 83706-1309
Phone (208) 367-2161

2929 E Magic View Dr
Meridian, ID 83642-3560
Phone (208) 954-8127

3325 Pocahontas Rd
Baker City, OR 97814-1464
Phone (541) 523-8137

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
85.82 of 100Reported as group
Quality
100
Improvement activities
40
Cost
52.72

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Intermountain Medical Imaging LLC CurrentSince Jun 12, 2023 Accepting new patients

Locations

1055 N Curtis Rd
Boise, ID 83706
Phone (208) 367-2152

927 W Myrtle St
Boise, ID 83702
Phone (208) 367-7510

323 E Riverside Dr
Ste 108
Eagle, ID 83616
Phone (208) 367-5700

2929 E Magic View Dr
Meridian, ID 83642
Phone (208) 367-8222

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 9

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": "1490918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490918400000",
    "number": "1811429681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2465 S 3RD STREET PLZ",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681081707",
            "telephone_number": "253-740-0951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 N COUNTRY RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772119",
            "telephone_number": "631-686-2517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUECK",
        "first_name": "NICHOLAS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-31",
        "last_updated": "2017-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson, NY

Sources for this page

Verify at the official NPI Registry.