NPIMap

Individual provider Active NPI

Melissa Nietert, AGPCNP-BC

  • Adult Health Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1881099380
Registry record updated Oct 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
209.012079 Issued in IL
Practice address
5841 S Maryland Ave
Chicago, IL 60637-1447
Phone
(773) 926-1191
Fax
(773) 926-0833
NPI assigned
Oct 27, 2014
Last updated
Oct 27, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 209.012079 IL Primary

Addresses

Primary practice location

5841 S Maryland Ave
Chicago, IL 60637-1447

Mailing address

5841 S Maryland Ave
Chicago, IL 60637-1447
Phone (773) 926-1191

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
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
I20190212003131 SD Practitioner - Nurse Practitioner 8325364342 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera McKennanGroup PAC ID 0345157103, 957 clinicians

Practice addresses (Care Compare)

1000 E 23Rd St
Suite 230
Sioux Falls, SD 57105-2122
Phone (605) 322-6900

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209.012079ILMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince Jan 14, 2019 Accepting new patients
Avera McKennan CurrentSince Jan 14, 2019 Accepting new patients
Avera McKennan Current Accepting new patients
Avera McKennan Past Accepting new patients

Locations

400 22nd Ave
Brookings, SD 57006
Phone (605) 692-6236

1000 E 23rd St
Ste 230
Sioux Falls, SD 57105
Phone (605) 322-6900

Organizations & group practices 4

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 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1414368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414368000000",
    "number": "1881099380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5841 S MARYLAND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606371447",
            "telephone_number": "773-926-1191",
            "fax_number": "773-926-0833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5841 S MARYLAND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606371447",
            "telephone_number": "773-926-1191",
            "fax_number": "773-926-0833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIETERT",
        "first_name": "MELISSA",
        "credential": "AGPCNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-27",
        "last_updated": "2014-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IL",
            "license": "209.012079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.