Glen D Nydam, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

542 Issued in SD

Practice address

305 N Sanborn Blvd
Mitchell, SD 57301-2449

Phone

(605) 996-2537

Fax

(605) 996-0500

NPI assigned

Jan 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in SD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Southern California College of Optometry, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mabee Eye Clinic PCGroup PAC ID 2365438116, 3 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Mabee Eye Clinic PC

  • Optometrist
  • Mitchell, SD
  • NPI 1578519864
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668038400000",
    "number": "1003887688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 N SANBORN BLVD",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573012449",
            "telephone_number": "605-996-2537",
            "fax_number": "605-996-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 N SANBORN BLVD",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573012449",
            "telephone_number": "605-996-2537",
            "fax_number": "605-996-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NYDAM",
        "first_name": "GLEN",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-31",
        "last_updated": "2022-11-10",
        "certification_date": "2022-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SD",
            "license": "542",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SANFORD HEALTH PLAN",
            "identifier": "20048",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAKOTACARE",
            "identifier": "9170527",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9203192",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BCBS",
            "identifier": "0006936",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIDLANDS CHOICE",
            "identifier": "230048",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9203190",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nelson Neurology, P.C.
• Carol B Nelson, MD
• Angela Kay Neugebauer
• James Leroy Nielsen, M.D.
• Kellie Jane Nielsen, LPC
• Julie Annette Oines, MA-CCC/SLP
• Filemon Evangelista Olegario, MD
• Jonathan Caceres Olegario, M.D.
• Sandra K Oleson, OTR/L
• Dani Olsen

• Optometrist in Mitchell, SD
• Providers in Mitchell, SD by specialty
• Optometrist in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.