Mark Roland Nickle, FNP in Roy, UT - Medicare Nurse Practitioner

Mark Roland Nickle, FNP is a medicare enrolled "Nurse Practitioner - Family" in Roy, Utah. His current practice location is 5305 S 1900 W, Roy, Utah. You can reach out to his office (for appointments etc.) via phone at (801) 825-5648.

Mark Roland Nickle is licensed to practice in Utah (license number 6234684-4405) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1134769342.

Contact Information

	Mark Roland Nickle, FNP
	5305 S 1900 W, Roy, UT 84067-2906
	(801) 825-5648
	Not Available

Map and Direction

Provider's Profile

Full Name	Mark Roland Nickle
Gender	Male
Speciality	Nurse Practitioner - Family
Location	5305 S 1900 W, Roy, Utah
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1134769342
Provider Enumeration Date: 01/15/2020
Last Update Date: 05/27/2021

Medicare PECOS Information:

PECOS PAC ID: 5092136234
Enrollment ID: I20200526003054

Medical Identifiers

Medical identifiers for Mark Roland Nickle such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1134769342	NPI	-	NPPES
1134769342	Medicaid	UT

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363L00000X	Nurse Practitioner	6234684-4405 (Utah)	Secondary
363LF0000X	Nurse Practitioner - Family	6234684-4405 (Utah)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mark Roland Nickle allows following entities to bill medicare on his behalf.

Entity Name	Utah Kidney Clinic Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1013520154 PECOS PAC ID: 7719306091 Enrollment ID: O20201006002557

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mark Roland Nickle is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Mark Roland Nickle, FNP 249 S 1050 E, Layton, UT 84041-4499 Ph: (801) 663-3126	Mark Roland Nickle, FNP 5305 S 1900 W, Roy, UT 84067-2906 Ph: (801) 825-5648

Reviews and Comments

Nurse Practitioner Nurses in Roy, UT

Jerrica Elizabeth Stoddard, FNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 5640 S 3500 W, Roy, UT 84067 Phone: 801-773-2838 Fax: 801-773-3025
Mr. Phil H Johnson, NP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 3485 W 5200 S, Roy, UT 84067 Phone: 801-475-3900 Fax: 801-475-3901
Emily Shanafelt, FNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 3485 W 5200 S, Roy, UT 84067 Phone: 801-475-3900 Fax: 801-475-3901
Sarah Breckinridge Wadhams, FNP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 3485 W 5200 S, Roy, UT 84067 Phone: 801-475-3900 Fax: 801-475-3901
Sandra Lowe Johnson, APRN Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 4254 S 2450 W, Roy, UT 84067 Phone: 801-388-8086
Jill Woodring, NP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 3443 W 5600 S, Roy, UT 84067 Phone: 801-773-4840 Fax: 801-525-8151

Mark Roland Nickle, FNP - Medicare Nurse Practitioner in Roy, UT