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Active NPI 1134769342 Individual Practitioner Male Practitioner

Mark Roland Nickle , FNP

Nurse Practitioner - Family • Roy, UT

Professional Overview & Biography Verified Profile Summary

Mark Nickle, FNP is a registered healthcare professional specializing in Nurse Practitioner - Family in Roy, UT. Practice services are available at 5305 S 1900 W under active NPI credentials.

Frequently performed procedures and clinical services include established patient outpatient office visit, dialysis services, 2-3 physician visits per month (20 years or older), new patient outpatient office visit. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

5305 S 1900 W

Roy, UT 840672906

Telephone 8018255648
Associated Practice Facility / Clinic
🏢 Utah Cvs Pharmacy, L.l.c. Facility NPI 1952735375

Specialty Benchmarks & Practice Insights

Comparative analytics for Nurse Practitioner - Family in Roy, UT

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.3 Yrs
State Avg: 7.2 Yrs
Regional Practice Density
14 Specialists

Practicing in Roy, UT (2184 Statewide)

Telehealth Adoption Rate
7.1% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.9% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)
Reporting Year:
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more
84 49 $315.18 $86.01
90961 Dialysis services, 2-3 physician visits per month (20 years or older)
39 28 $713.83 $235.84
99213 Established patient office or other outpatient visit, typically 15 minutes
30 24 $223.48 $64.29
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more
28 28 $410.95 $135.22
90960 Dialysis services, 4 or more physician visits per month (20 years or older)
22 20 $859.53 $284.71
90962 Dialysis services, 1 physician visit per month (20 years or older)
19 16 $492.80 $162.40

Medical Specialties & State Licenses

CMS Verified: 2021-05-27
Nurse Practitioner - Family Primary Specialty

NUCC Taxonomy Code: 363LF0000X

State License UT 6234684-4405

Definition to come...

Nurse Practitioner

NUCC Taxonomy Code: 363L00000X

State License UT 6234684-4405

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
1134769342 (UT)

Secondary Practice Locations

3702 S State St Ste 107

South Salt Lake, UT 841155096

Phone: 8012882634

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

2 Associated Practitioners
Jamie Gleason

Pharmacist

NPI 1245160845
NPI 1326614686

Doctor of Pharmacy (Pharm.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

10 Historical Events
📍
Updated Practice Location May 27, 2021

Registered at 5305 S 1900 W, ROY, UT 840672906 (Tel: 8018255648)

👤
Provider Name / Credentials Updated May 27, 2021

Recorded as MARK NICKLE, FNP

📍
Updated Practice Location March 25, 2021

Registered at 3702 S STATE ST STE 107, SOUTH SALT LAKE, UT 841155096 (Tel: 8012882634)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) March 25, 2021

Nurse Practitioner (License #6234684-4405 in UT)

NPI Profile Active January 15, 2020

NPI status registered as active in NPPES database

📍
Updated Practice Location January 15, 2020

Registered at 249 S 1050 E, LAYTON, UT 840414499 (Tel: 8016633126)

📍
Updated Business Mailing Address January 15, 2020

Registered at 249 S 1050 E, LAYTON, UT 840414499 (Tel: 8016633126)

👤
Provider Name / Credentials Updated January 15, 2020

Recorded as MARK NICKLE

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) January 15, 2020

Nurse Practitioner (License #6234684-4405 in UT)

🟢
Initial NPI Registration & Enumeration January 15, 2020

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1134769342
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: January 15, 2020
Last Update: May 27, 2021
Sole Proprietor: Yes

Mailing Address

249 S 1050 E

Layton, UT 840414499

Phone: 8016633126

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.