Shannelle Susanne Rico, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01050363A Issued in IN

Practice address

Rosebud IHS Hospital
Soldier Creek Road
Rosebud, SD 57570-0400

Phone

(605) 747-3245

Fax

(605) 747-2216

NPI assigned

Mar 27, 2006

Sex

Female

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 2

Other names 1

• Shannelle Susanne Rico Professional name

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Great Plains Tribal Chairmen'S Health Board

  • Pharmacy
  • Rapid City, SD
  • NPI 1376105452

  TX

  Medicare reassignment NPD
• Rosebud Indian Health Service

  • General Acute Care Hospital
  • Rosebud, SD
  • NPI 1194757369

  TX

  Medicare reassignment NPD
• US Health Dept of Health & Human Services

  • Rural Health Clinic/Center
  • Poplar, MT
  • NPI 1972694602

  TX

  Medicare reassignment NPD
• Rosebud Indian Health Service

  • Ambulatory Surgical Clinic/Center
  • Rosebud, SD
  • NPI 1790955128
  NPD
• Fayette Memorial Hospital Association Inc.

  • General Acute Care Hospital
  • Connersville, IN
  • NPI 1508825720
  NPD (past)

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437004800000",
    "number": "1023078623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "HWY 77/75",
            "address_2": "P.O. BOX HH",
            "city": "WINNEBAGO",
            "state": "NE",
            "postal_code": "680710767",
            "telephone_number": "402-878-2231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ROSEBUD IHS HOSPITAL",
            "address_2": "SOLDIER CREEK ROAD",
            "city": "ROSEBUD",
            "state": "SD",
            "postal_code": "575700400",
            "telephone_number": "605-747-3245",
            "fax_number": "605-747-2216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICO",
        "first_name": "SHANNELLE",
        "middle_name": "SUSANNE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-27",
        "last_updated": "2015-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01050363A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "000000378568",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200381310",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNELLE",
            "last_name": "RICO",
            "middle_name": "SUSANNE",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Phyllis Charity Provancial, REGISTERED NURSE
• Carole A Provencial, REGISTERED NURSE
• Lucy Maria Reifel, MD
• Amy L Reindl, DPT
• Carolyn L Reiser, REGISTERED NURSE
• Carmelle Roach, REGISTERED NURSE
• Melissa Kaye Rodriguez, PHARM.D.
• Rosebud Comprehensive Health Care Facility
• Rosebud IHS Hospita;L
• Rosebud IHS Hospital

• Family Medicine Physician in Rosebud, SD
• Providers in Rosebud, SD by specialty
• Family Medicine Physician in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.