NPIMap

Individual provider Active NPI

Tia Michelle Gullickson, FNP-C

  • Family Nurse Practitioner
  • Red Lake Falls, MN
National Provider Identifier
1992187868
Registry record updated Jun 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
CNP 3937 Issued in MN
Practice address
105 International Dr
Ste. 126
Red Lake Falls, MN 56750-4665
Phone
(218) 253-4606
Fax
(218) 253-4681
NPI assigned
Jun 26, 2015
Last updated
Jun 26, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X CNP 3937 MN Primary

Addresses

Primary practice location

105 International Dr
Ste. 126
Red Lake Falls, MN 56750-4665

Mailing address

105 International Dr
Ste. 126
Red Lake Falls, MN 56750-4665
Phone (218) 253-4606

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
I20150717001787 MN Practitioner - Nurse Practitioner 0749593804 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Riverview Healthcare AssociationGroup PAC ID 7810806718, 46 clinicians

Practice addresses (Care Compare)

105 International Dr
Red Lake Falls, MN 56750-4665
Phone (218) 281-9200

323 S Minnesota St
Crookston, MN 56716-1601
Phone (218) 281-9200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.91 of 100Reported as group
Quality
88.07
Promoting interoperability
100
Improvement activities
40
Cost
74.95

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CNP 3937MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Riverview Healthcare Association Current Accepting new patients
Riverview Healthcare Association CurrentSince Jul 1, 2015 Accepting new patients
Riverview Healthcare Association Current Accepting new patients
Riverview Healthcare Association CurrentSince Jul 1, 2015 Accepting new patients
Riverview Healthcare Association Past Accepting new patients

Locations

323 S Minnesota St
Crookston, MN 56716
Phone (218) 281-9200

105 International Dr
Rl Falls, MN 56750
Phone (218) 253-3480

Organizations & group practices 5

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 8

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": "1435276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435276800000",
    "number": "1992187868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 INTERNATIONAL DR",
            "address_2": "STE. 126",
            "city": "RED LAKE FALLS",
            "state": "MN",
            "postal_code": "567504665",
            "telephone_number": "218-253-4606",
            "fax_number": "218-253-4681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 INTERNATIONAL DR",
            "address_2": "STE. 126",
            "city": "RED LAKE FALLS",
            "state": "MN",
            "postal_code": "567504665",
            "telephone_number": "218-253-4606",
            "fax_number": "218-253-4681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GULLICKSON",
        "first_name": "TIA",
        "middle_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-26",
        "last_updated": "2015-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "CNP 3937",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Red Lake Falls, MN

Sources for this page

Verify at the official NPI Registry.