NPIMap

Individual provider Active NPI

Jennifer Lee Tegethoff, MD

  • Pediatrics Physician
  • Mitchell, SD
National Provider Identifier
1003882416
Registry record updated Jan 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
5460 Issued in SD
Practice address
1200 E 6TH Ave
Mitchell, SD 57301-2922
Phone
(605) 996-6368
Fax
(605) 996-6660
NPI assigned
Feb 24, 2006
Last updated
Jan 10, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 5460 SD Primary

Addresses

Primary practice location

1200 E 6TH Ave
Mitchell, SD 57301-2922

Mailing address

1200 E 6TH Ave
Mitchell, SD 57301-2922
Phone (605) 996-6368

Other identifiers 1

IdentifierTypeStateIssuer
6701740MedicaidSD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210421002834 SD Practitioner - Pediatric Medicine 6204134018 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince Jan 7, 2021 Accepting new patients
Avera McKennan Current Accepting new patients
Avera McKennan CurrentSince Jan 7, 2021 Accepting new patients
Avera Queen of Peace Current Accepting new patients
Pediatrics Plus LLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: jennifer.tegethoff@avera.sdhealthlink.net

Ownership & related parties

All facility ownership & control disclosures 7

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Avera Weskota Memorial Medical CenterWessington Springs, SD, CCN 431324 Hospital Corporate Director Jul 1, 2022
Avera Weskota Memorial Medical CenterWessington Springs, SD, CCN 43Z324 Hospital Corporate Director Jul 1, 2021
Avera de Smet Memorial HospitalDe Smet, SD, CCN 431332 Hospital Corporate Director Jul 1, 2021
Avera de Smet Memorial HospitalDe Smet, SD, CCN 43Z332 Hospital Corporate Director Jul 1, 2021
Avera Queen of Peace HospitalMitchell, SD, CCN 431340 Hospital Corporate Director Jul 1, 2021
Avera Queen of Peace HospitalMitchell, SD, CCN 43Z340 Hospital Corporate Director Jul 1, 2021
Avera Brady Health and RehabMitchell, SD, CCN 435061 Skilled nursing facility Managing Control - Governing Body Jul 1, 2021

Owned or controlled facilities with NPI records 7

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1140739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357776000000",
    "number": "1003882416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 E 6TH AVE",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573012922",
            "telephone_number": "605-996-6368",
            "fax_number": "605-996-6660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 E 6TH AVE",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573012922",
            "telephone_number": "605-996-6368",
            "fax_number": "605-996-6660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEGETHOFF",
        "first_name": "JENNIFER",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-24",
        "last_updated": "2013-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SD",
            "license": "5460",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6701740",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mitchell, SD

Sources for this page

Verify at the official NPI Registry.