Jane Marie Vansickle, PHD, LP
Individual provider Active NPI Psychologist · Granite Falls, MN
NPI 1992852602 · NPPES record last updated Jan 20, 2019
Key facts
- NPI
- 1992852602
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- LP3973 (MN)
- Practice address
- 345 10TH Ave
Granite Falls, MN 56241-1442 - Phone
- (320) 564-6200
- NPI assigned
- Jan 4, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Avera Granite Falls
Practice addresses (Care Compare)
345 10TH Ave
Granite Falls, MN 56241-1442
Phone (320) 564-3111
345 10TH Ave
Granite Falls, MN 56241-1499
Hospital & facility affiliations
- Avera Granite Falls
Merit-based Incentive Payment System (MIPS)
- Final score
- 95.27 of 100
- Quality
- 85.98
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170906002970 | MN | Practitioner - Clinical Psychologist | 7416220884 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP3973 | MN | MD | Psychologist |
| 10537 | NC | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Avera Granite Falls | Current |
Accepting new patients | |
| Avera Granite Falls | Current | Accepting new patients |
Locations
345 10th Ave
Granite Falls, MN 56241
Phone (320) 564-3111
300 S Bruce St
Marshall, MN 56258
Phone (507) 532-9631
Interoperability endpoints
- jane.van.sickle@avera.sdhealthlink.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 10537 | NC | |
| Psychologist | 103T00000X | LP3973 | MN | Yes |
Addresses
Primary practice location
345 10TH Ave
Granite Falls, MN 56241-1442
Mailing address
345 10TH Ave
Granite Falls, MN 56241-1442
Phone (612) 564-6200
Other practice location 1
152 Capcom Ave Ste 101
Wake Forest, NC 27587-6585
Phone (919) 818-0382
Other providers in Granite Falls, MN
- Todd E Trudel
- Alexandra Tulintseff
- Two Three Counseling PLLC
- Upper Sioux Community
- Upper Sioux Community Social Services
- Bridget Samone Varpness
- Stephanie Jo Ward
- Nicole Wellendorf
- Yellow Medicine County Family Services
- Yellow Medicine East District 2190
All providers in Granite Falls, MN · Psychologist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 20, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.