Jerome Matthew Guanciale, DO

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

17750 Issued in ND

Practice address

332 2ND Ave N
Wahpeton, ND 58075-4528

Phone

(701) 642-7000

Fax

(701) 642-7055

NPI assigned

Apr 13, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MN, ND2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

General Surgery

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sanford Medical Center Fargo 1,210 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Francis Medical Center Hospital, Breckenridge, MN, CCN 241377
• Sanford Medical Center Fargo Hospital, Fargo, ND, CCN 350011

Merit-based Incentive Payment System (MIPS)

Final score

88.99 of 100Reported as group

Quality

92.39

Promoting interoperability

100

Improvement activities

40

Cost

70.9

Merit-based Incentive Payment System (MIPS)

Final score

1.88 of 100Reported as group

Quality

0

Improvement activities

0

Merit-based Incentive Payment System (MIPS)

Final score

82.73 of 100Reported as group

Quality

71.75

Promoting interoperability

100

Improvement activities

40

Cost

70.68

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jguanciale17259050@direct.sanfordhealth.org

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.

• Sanford Medical Center Fargo

  • Family Medicine Physician
  • West Fargo, ND
  • NPI 1184917924

  Family Medicine, MN, ND

  Medicare reassignment NPD
• Sanford Medical Center Fargo

  • General Acute Care Hospital
  • Fargo, ND
  • NPI 1528009412
  NPD
• Carolina Coastal Plastic and Reconstructive Surgery, Inc.

  • Plastic and Reconstructive Surgery Physician
  • Myrtle Beach, SC
  • NPI 1003096058
  NPD (past)
• JS-Bell Enterprises, LLC

  • Plastic Surgery Physician
  • North Myrtle Beach, SC
  • NPI 1588993646

  Family Medicine

  NPD (past)
• Mychiromed, P.a.

  • Chiropractor
  • Myrtle Beach, SC
  • NPI 1063465045
  NPD (past)

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

• Sanford Medical Center Fargo

  • Family Medicine Physician
  • West Fargo, ND
  • NPI 1184917924

  Hospital

  Care Compare affiliation
• Sanford Medical Center Fargo

  • General Acute Care Hospital
  • Fargo, ND
  • NPI 1245519081

  Hospital

  Care Compare affiliation
• Sanford Medical Center Fargo

  • General Acute Care Hospital
  • Fargo, ND
  • NPI 1528009412

  Hospital

  Care Compare affiliation
• Sanford Medical Center Fargo

  • Air Ambulance
  • Fargo, ND
  • NPI 1942415468

  Hospital

  Care Compare affiliation
• Sanford Health of Northern Minnesota

  • Ambulatory Surgical Clinic/Center
  • Bemidji, MN
  • NPI 1093876922

  Hospital

  Care Compare affiliation
• St. Francis Medical Center

  • Critical Access Hospital
  • Breckenridge, MN
  • NPI 1639162381

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1144886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651190400000",
    "number": "1851355366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074",
            "telephone_number": "605-328-6585",
            "fax_number": "605-312-9802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "332 2ND AVE N",
            "city": "WAHPETON",
            "state": "ND",
            "postal_code": "580754528",
            "telephone_number": "701-642-7000",
            "fax_number": "701-642-7055"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1301 Bertha Howe Ave",
            "address_2": "Ste. 1",
            "address_purpose": "LOCATION",
            "city": "Mesquite",
            "state": "NV",
            "postal_code": "890277502",
            "country_code": "US",
            "telephone_number": "702-346-0800",
            "fax_number": "702-346-0801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUANCIALE",
        "first_name": "JEROME",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-13",
        "last_updated": "2022-04-29",
        "certification_date": "2022-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MN",
            "license": "70737",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "SC",
            "license": "0393",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NV",
            "license": "DO2175",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "ND",
            "license": "17750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jguanciale17259050@direct.sanfordhealth.org",
            "affiliation": "N",
            "address_1": "332 2nd Ave N",
            "city": "Wahpeton",
            "state": "ND",
            "country_code": "US",
            "postal_code": "580754528",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Richard L Geiselhart, PHD
• Ariane M Getz, PSY.D.
• Ashley Gilbertson
• Debra Jane Glander, DPT
• Lucas Bradley Glarum, PHARM.D
• Dorothy Haire
• Mason T Haley, DDS
• Sarah Haley
• James Edward Halvorson, MD
• Emily Donna Hanson

• All providers in Wahpeton, ND
• Surgery Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 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.