NICOLE S BURKETTE IKEBATA (MD, MPH) – Student in an Organized Health Care Education/Training Program, NPI 1972964849
Student in an Organized Health Care Education/Training Program
Main info
Doctor Profile
Contacts
Profile Insights
NPPES metrics only — not quality of care.
607 PSYCHIATRY in CO
Provider Addresses for NICOLE S BURKETTE IKEBATA (MD, MPH)
3609 Austin Bluffs Pkwy Ste 31
Colorado Springs, CO 809186658
Phone: (205) 964-2924
Type: Location
308 E Burlington St
Iowa City, IA 522401602
Phone: (651) 243-8113
Type: Location
345 Smith Ave N
Saint Paul, MN 551022346
Phone: (651) 220-6700
Type: Location
2525 Chicago Ave
Minneapolis, MN 554044518
Phone: (612) 813-6000
Type: Location
Providence Sacred Heart Medical Center and Children's Hospital, 101, West 8th Avenue, Spokane, Spokane County, Washington, 99204, United States
SPOKANE, WA 992042307
Phone: (509) 474-4744
Type: Mailing
2355 HIGHWAY 36 W STE 400
ROSEVILLE, MN 551133905
Phone: (651) 243-8113
Fax: (931) 202-8451
Type: Mailing
2925 CHICAGO AVE
MINNEAPOLIS, MN 554071321
Phone: (612) 262-5000
Type: Mailing
800 E 28TH ST FL 6
MINNEAPOLIS, MN 554073723
Phone: (612) 863-5327
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2021-09-20
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20210920003144 | I | Psychiatry | MN | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 80918)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Pulmonary Disease | CO | |
| Qualified Audiologist | MN | |
| Family Practice | MN | |
| - | MN | |
| Family Practice | MN | |
| Nurse Practitioner | ND | |
| - | MN | |
| - | MN | |
| - | MN | |
| - | MN |
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