NPIMap

Individual provider Active NPI

Brock J Doubledee, D.O.

  • Pediatric Gastroenterology Physician
  • Sioux Falls, SD
National Provider Identifier
1013994730
Registry record updated Apr 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
5852 Issued in SD
Practice address
1600 W 22ND
Sioux Falls, SD 57105-1521
Phone
(605) 312-1000
Fax
(605) 312-1001
NPI assigned
Dec 22, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 47322 MN
Pediatric Gastroenterology Physician 2080P0206X 5852 SD Primary

Addresses

Primary practice location

1600 W 22ND
Sioux Falls, SD 57105-1521

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074
Phone (605) 312-1000

Other identifiers 1

IdentifierTypeStateIssuer
620933500MedicaidMN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bdoubledee3889@direct.sanfordhealth.org

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
I20080513000007 SD Practitioner - Pediatric Medicine 4284688813 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
84.78 of 100Reported as group
Quality
78.77
Promoting interoperability
100
Improvement activities
40
Cost
70.49

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
47322MNMDPediatrics Physician
5852SDMDPediatric Gastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center CurrentSince Nov 18, 2019 Accepting new patients
Sanford Clinic CurrentSince Jan 1, 2007 Accepting new patients
Sanford Health Network CurrentSince May 1, 2014 Accepting new patients
Sanford Health Network Current Accepting new patients
Sanford Health Network CurrentSince May 1, 2014 Accepting new patients
Sanford Clinic Pediatrics CurrentSince Jan 1, 2007 Accepting new patients
Sanford Clinic Current Accepting new patients
Sanford Medical Center CurrentSince Nov 18, 2019 Accepting new patients
Sanford Clinic Past Accepting new patients

Locations

701 3rd Ave S
Clear Lake, SD 57226
Phone (605) 874-2141

525 N Foster St
Mitchell, SD 57301
Phone (605) 995-2000

4405 E 26th St
Sioux Falls, SD 57103
Phone (605) 328-9000

1600 W 22nd St
Sioux Falls, SD 57105
Phone (605) 312-1000

1305 W 18th St
Sioux Falls, SD 57105
Phone (605) 312-7300

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1135209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649030400000",
    "number": "1013994730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074",
            "telephone_number": "605-312-1000",
            "fax_number": "605-312-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W 22ND",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051521",
            "telephone_number": "605-312-1000",
            "fax_number": "605-312-1001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUBLEDEE",
        "first_name": "BROCK",
        "middle_name": "J",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-22",
        "last_updated": "2022-04-04",
        "certification_date": "2022-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "47322",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "SD",
            "license": "5852",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "620933500",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bdoubledee3889@direct.sanfordhealth.org",
            "affiliation": "N",
            "address_1": "1600 W 22nd",
            "city": "Sioux Falls",
            "state": "SD",
            "country_code": "US",
            "postal_code": "571051521",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.