Amber Jane Van Sickle-Birch, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

70572 Issued in ID

Practice address

1500 Pancheri Dr Ste 4
Idaho Falls, ID 83402-3212

Phone

(208) 579-6087

Fax

(888) 519-8898

NPI assigned

Jun 28, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

High Tide Psychiatry PLLCGroup PAC ID 8527444835, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• High Tide Psychiatry, PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Idaho Falls, ID
  • NPI 1023762119
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1593302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662422400000",
    "number": "1831716604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 PANCHERI DR STE 4",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834023212",
            "telephone_number": "208-579-6087",
            "fax_number": "888-519-8898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 PANCHERI DR STE 4",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834023212",
            "telephone_number": "208-579-6087",
            "fax_number": "888-519-8898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN SICKLE-BIRCH",
        "first_name": "AMBER",
        "middle_name": "JANE",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-28",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "ID",
            "license": "43554",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "ID",
            "license": "70572",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mohini Vadalia
• Colter Valcarce, DPT
• Itzel Valencia, BS
• Validations Inc.
• Valley Medical Shoppe Inc
• Jason Van Sickle, D.C.
• Sharli Elizabeth Van Wagenen, BS
• Carl David Vance, MD
• Peter L Vance, MD
• Spencer Vandenburg, OTR/L

• Psychiatric/Mental Health Nurse Practitioner in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Psychiatric/Mental Health Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.