NPIMap

Organization Active NPI

Childrens Home Society of South Dakota

  • Psychiatry Physician
  • Rapid City, SD
National Provider Identifier
1003411745
Registry record updated Aug 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
CHILDRENS HOME SOCIETY OF SOUTH DAKOTA
Practice address
5301 US-16 West
Rapid City, SD 57701-8700
Phone
(605) 393-4278
Fax
(605) 341-7437
NPI assigned
Dec 1, 2020
Last updated
Aug 14, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
CHILDREN'S HOME SOCIETY OF SOUTH DAKOTAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 14, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gilbert Johnson
Title
Analyst
Phone
(605) 965-3149

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

5301 US-16 West
Rapid City, SD 57701-8700

Mailing address

801 N Sycamore Ave
Sioux Falls, SD 57110-5746
Phone (605) 334-6004

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240620001344 SD Part B Supplier - Clinic/Group Practice 8123561032 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rapid City, SD; Sioux Falls, SD

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Childrens Home Society of South Dakota4 organizations share this tax ID, including this one
Part of
Childrens Home Society of South Dakota

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723593600000",
    "number": "1003411745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 N SYCAMORE AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571105746",
            "telephone_number": "605-334-6004",
            "fax_number": "605-335-2776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5301 US-16 WEST",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577018700",
            "telephone_number": "605-393-4278",
            "fax_number": "605-341-7437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDRENS HOME SOCIETY OF SOUTH DAKOTA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHILDREN'S HOME SOCIETY OF SOUTH DAKOTA",
        "enumeration_date": "2020-12-01",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-08",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "GILBERT",
        "authorized_official_title_or_position": "ANALYST",
        "authorized_official_telephone_number": "605-965-3149"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rapid City, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.