Individual provider Active NPI

Jenna R Nickels, PA-C

  • Physician Assistant
  • Bismarck, ND
National Provider Identifier
1952554826
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PAC0682 Issued in ND
Practice address
225 N 7TH St
Bismarck, ND 58501-4417
Phone
(701) 323-6140
NPI assigned
Oct 23, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PAC0682 ND Primary

Addresses

Primary practice location

225 N 7TH St
Bismarck, ND 58501-4417

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074
Phone (605) 328-6585

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jnickels9871171@direct.sanfordhealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
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

Enrollment IDStateProvider typePAC IDDetails
I20170707001213 ND Practitioner - Physician Assistant 3274696851 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford BismarckGroup PAC ID 9739098575, 562 clinicians

Practice addresses (Care Compare)

225 N 7TH St
Bismarck, ND 58501-4417
Phone (701) 323-8922

300 N 7TH St
Bismarck, ND 58501-4439
Phone (701) 323-6000

3318 N 14TH St
Bismarck, ND 58503-1614
Phone (701) 323-8300

801 21St Ave SE
Minot, ND 58701-6064
Phone (701) 838-3150

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.63 of 100Reported as group
Quality
89.39
Promoting interoperability
100
Improvement activities
40
Cost
76.04

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Bismarck CurrentSince Jun 1, 2017 Accepting new patients
Sanford Bismarck CurrentSince Jun 1, 2017 Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients

Locations

3318 N 14th St
Bismarck, ND 58503
Phone (701) 323-8300

225 N 7th St
Bismarck, ND 58501
Phone (701) 224-9471

801 21st Ave SE
Minot, ND 58701
Phone (701) 838-3033

Interoperability endpoints

  • Direct secure messaging: jnickels9871171@direct.sanfordhealth.org

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1224720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1952554826",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 N 7TH ST",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585014417",
            "telephone_number": "701-323-6140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKELS",
        "first_name": "JENNA",
        "middle_name": "R",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-23",
        "last_updated": "2022-07-21",
        "certification_date": "2022-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ND",
            "license": "PAC0682",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jnickels9871171@direct.sanfordhealth.org",
            "affiliation": "N",
            "address_1": "225 N 7th St",
            "city": "Bismarck",
            "state": "ND",
            "country_code": "US",
            "postal_code": "585014417",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bismarck, ND

Sources for this page

Verify at the official NPI Registry.