NPIMap

Individual provider Active NPI

David D Axtman, MS PA-C

  • Physician Assistant
  • Sioux Falls, SD
National Provider Identifier
1023081668
Registry record updated Mar 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
100569 Issued in IA
Practice address
1400 S Glendale Ave
1305 W. 18TH St.
Sioux Falls, SD 57105-1416
Phone
(605) 360-5369
NPI assigned
Feb 13, 2006
Last updated
Mar 25, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 25, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0428 SD
Physician Assistant 363A00000X 100569 IA Primary

Addresses

Primary practice location

1400 S Glendale Ave
1305 W. 18TH St.
Sioux Falls, SD 57105-1416

Mailing address

1400 S Glendale Ave
PO Box 5036
Sioux Falls, SD 57105-1416
Phone (605) 274-2587

Other identifiers 1

IdentifierTypeStateIssuer
6821932MedicaidSD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD, MN, IA3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20040726000789 SD Practitioner - Physician Assistant 8224018577 Reassigns benefits to 2 organizations
I20140728002446 MN Practitioner - Physician Assistant 8224018577 Reassigns benefits to 2 organizations
I20201008002534 IA Practitioner - Physician Assistant 8224018577 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
City of BrookingsGroup PAC ID 1052307105, 112 clinicians

Practice addresses (Care Compare)

300 22ND Ave
Brookings, SD 57006-2480
Phone (605) 692-6351

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Physician Assistant

State licenses

LicenseStateTypeSpecialty
100569IAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Avera St Marys CurrentSince Mar 1, 2022 Accepting new patients
City of Brookings CurrentSince Jan 25, 2024 Accepting new patients
County of Murray CurrentSince Jun 2, 2014 Accepting new patients
Avera St Marys CurrentSince Mar 1, 2022 Accepting new patients

Locations

2042 Juniper Ave
Slayton, MN 56172
Phone (507) 836-1227

300 22nd Ave
Brookings, SD 57006
Phone (605) 692-6351

Organizations & group practices 8

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1139788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648166400000",
    "number": "1023081668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 S GLENDALE AVE",
            "address_2": "PO BOX 5036",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051416",
            "telephone_number": "605-274-2587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 S GLENDALE AVE",
            "address_2": "1305 W. 18TH ST.",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051416",
            "telephone_number": "605-360-5369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AXTMAN",
        "first_name": "DAVID",
        "middle_name": "D",
        "credential": "MS PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-13",
        "last_updated": "2022-03-25",
        "certification_date": "2022-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SD",
            "license": "0428",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "100569",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6821932",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.