West River Dermatology, PC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

0266 Issued in SD

Legal business name

WEST RIVER DERMATOLOGY, PC

Practice address

717 Meade St
Suite 100
Rapid City, SD 57701-5100

Phone

(605) 341-5910

Fax

(605) 341-9052

NPI assigned

Sep 6, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Roger S Knutsen, M.D.

Title

President

Phone

(605) 341-5910

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Justin Thurman, PA-C

  • Surgical Physician Assistant
  • Fort Meade, SD
  • NPI 1770660102
  NPD (past)
• Karen Kay Zepp, P.A.

  • Medical Physician Assistant
  • Rapid City, SD
  • NPI 1003886839
  NPD (past)

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205193600000",
    "number": "1013010974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "717 MEADE ST",
            "address_2": "SUITE 100",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577015100",
            "telephone_number": "605-341-5910",
            "fax_number": "605-341-9052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 MEADE ST",
            "address_2": "SUITE 100",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577015100",
            "telephone_number": "605-341-5910",
            "fax_number": "605-341-9052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST RIVER DERMATOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-06",
        "last_updated": "2008-03-11",
        "status": "A",
        "authorized_official_last_name": "KNUTSEN",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "605-341-5910",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "SD",
            "license": "0266",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0003099",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jenna Christine Werre, DC
• Alvin Wessel Jr.
• West Dakota Surgical Clinic
• West Dakota Surgical Clinic
• West River Anesthesiology Consultants PC
• West River Ear Nose and Throat, Prof., L.L.C.
• West River Foundation
• West River HV, PLLC
• West River Men'S Health PC
• West River Physicians Alliance, LLC

• MOHS-Micrographic Surgery Physician in Rapid City, SD
• Providers in Rapid City, SD by specialty
• MOHS-Micrographic Surgery Physician in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.