NPIMap

Individual provider Active NPI

Nicole Therese Manecke, PA

  • Medical Physician Assistant
  • Baxter, MN
National Provider Identifier
1821180712
Registry record updated Jul 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
085-001851 Issued in IL
Practice address
13359 Isle Dr
Suite 3
Baxter, MN 56425-2222
Phone
(218) 454-7546
Fax
(218) 454-3062
NPI assigned
Sep 28, 2006
Last updated
Jul 9, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2008

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 085-001851 IL Primary

Addresses

Primary practice location

13359 Isle Dr
Suite 3
Baxter, MN 56425-2222

Mailing address

13359 Isle Dr
Suite 3
Baxter, MN 56425-2222
Phone (218) 454-7546

Other identifiers 1

IdentifierTypeStateIssuer
1720269426OtherMNDERMATOLOGY PROFESSIONALS, PA TYPE 2 NPI

Other names 1

  • Nicole Therese Reichmann Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20061228000056 MN Practitioner - Physician Assistant 3971503806 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dermatology Professionals, PAGroup PAC ID 4587753934, 9 clinicians

Practice addresses (Care Compare)

13359 Isle Dr
Suite 3
Baxter, MN 56425-2223
Phone (218) 454-7546

15167 Edgewood Dr
Suite 200
Brainerd, MN 56401-6948
Phone (218) 454-7546

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
98.53 of 100Reported as group
Quality
100
Promoting interoperability
99
Improvement activities
40
Cost
95.93

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
944MNMDMental Health Counselor
085-001851ILMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Dermatology Professionals PA CurrentSince Apr 1, 2008 Accepting new patients
Dermatology Professionals, PA Past Accepting new patients

Locations

13359 Isle Dr
Ste 3
Baxter, MN 56425
Phone (218) 454-7546

318 E Main St
Crosby, MN 56441
Phone (218) 546-8375

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 11

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": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215561600000",
    "number": "1821180712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13359 ISLE DR",
            "address_2": "SUITE 3",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564252222",
            "telephone_number": "218-454-7546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13359 ISLE DR",
            "address_2": "SUITE 3",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564252222",
            "telephone_number": "218-454-7546",
            "fax_number": "218-454-3062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANECKE",
        "first_name": "NICOLE",
        "middle_name": "THERESE",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-28",
        "last_updated": "2008-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085-001851",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DERMATOLOGY PROFESSIONALS, PA TYPE 2 NPI",
            "identifier": "1720269426",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "REICHMANN",
            "middle_name": "THERESE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Baxter, MN

Sources for this page

Verify at the official NPI Registry.