Nicholas Moore Southerton, CNP in Minneapolis, MN

Nicholas Moore Southerton, CNP is a medicare enrolled "Nurse Practitioner - Gerontology" in Minneapolis, Minnesota. His current practice location is 1415 Lilac Dr N, Minneapolis, Minnesota. You can reach out to his office (for appointments etc.) via phone at (763) 205-4168.

Nicholas Moore Southerton is licensed to practice in Minnesota (license number 10301) 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 1013691153.

Contact Information

	Nicholas Moore Southerton, CNP
	1415 Lilac Dr N, Minneapolis, MN 55422-4500
	(763) 205-4168
	Not Available

Map and Direction

Provider's Profile

Full Name	Nicholas Moore Southerton
Gender	Male
Speciality	Nurse Practitioner - Gerontology
Location	1415 Lilac Dr N, Minneapolis, Minnesota
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1013691153
Provider Enumeration Date: 06/09/2023
Last Update Date: 06/20/2023

Medicare PECOS Information:

PECOS PAC ID: 3678934783
Enrollment ID: I20230804000766

Medical Identifiers

Medical identifiers for Nicholas Moore Southerton such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1013691153	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LG0600X	Nurse Practitioner - Gerontology	10301 (Minnesota)	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. Nicholas Moore Southerton allows following entities to bill medicare on his behalf.

Entity Name	Twin Cities Physicians Professional Corporation
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1992176499 PECOS PAC ID: 9830499763 Enrollment ID: O20151130000202

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. Nicholas Moore Southerton 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
Nicholas Moore Southerton, CNP 2124 144th Ln Ne, Ham Lake, MN 55304-6260 Ph: (763) 248-4011	Nicholas Moore Southerton, CNP 1415 Lilac Dr N, Minneapolis, MN 55422-4500 Ph: (763) 205-4168

Reviews and Comments

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Nicholas Moore Southerton, CNP - Medicare Nurse Practitioner in Minneapolis, MN