28TH Medgrp-Ellsworth

Primary specialty

Military/U.S. Coast Guard Outpatient Clinic/CenterTaxonomy code 261QM1100X

Legal business name

28TH MEDGRP-ELLSWORTH

Practice address

2900 Doolittle Dr
Ellsworth AFB, SD 57706-4821

Phone

(605) 385-3311

Fax

(605) 385-3234

NPI assigned

Nov 29, 2005

Last updated

Jun 17, 2025By the provider in NPPES

Organization subpart

Yes

Parent organization

28TH MEDGRP-ELLSWORTHAs reported in NPPES

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

Authorized official

Name

Jen Lewandowski

Title

Dha Ubo

Phone

(703) 817-4030

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Ellsworth AFB MTF Other name

Tax ID family

28TH Medgrp-Ellsworth2 organizations share this tax ID, including this one

Part of

28TH Medgrp-Ellsworth

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• 28TH Medgrp-Ellsworth

  dba DoD ELLSWORTH ePhcy

  • Military/U.S. Coast Guard Pharmacy
  • Ellsworth AFB, SD
  • NPI 1710390570
  NPD tax ID

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

{
    "created_epoch": "1133222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750118400000",
    "number": "1023091642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 DOOLITTLE DR",
            "city": "ELLSWORTH AFB",
            "state": "SD",
            "postal_code": "577064821",
            "telephone_number": "605-385-3311",
            "fax_number": "605-385-3234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 DOOLITTLE DR",
            "city": "ELLSWORTH AFB",
            "state": "SD",
            "postal_code": "577064821",
            "telephone_number": "605-385-3311",
            "fax_number": "605-385-3234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "28TH MEDGRP-ELLSWORTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "28TH MEDGRP-ELLSWORTH",
        "enumeration_date": "2005-11-29",
        "last_updated": "2025-06-17",
        "certification_date": "2025-06-17",
        "status": "A",
        "authorized_official_last_name": "LEWANDOWSKI",
        "authorized_official_first_name": "JEN",
        "authorized_official_title_or_position": "DHA UBO",
        "authorized_official_telephone_number": "703-817-4030"
    },
    "taxonomies": [
        {
            "code": "261QM1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military/U.S. Coast Guard Outpatient",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1101X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military and U.S. Coast Guard Ambulatory Procedure",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332000000X",
            "taxonomy_group": "",
            "desc": "Military/U.S. Coast Guard Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5351000",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "4304969",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellsworth AFB MTF",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• 28TH Medgrp-Ellsworth (DoD ELLSWORTH ePhcy)
• Michael Andes
• Sarah Katherine Ayers, MD
• Stephen Beals
• Roger H Belisle, PH.D.

• Military/U.S. Coast Guard Outpatient Clinic/Center in Ellsworth AFB, SD
• Providers in Ellsworth AFB, SD by specialty
• Military/U.S. Coast Guard Outpatient Clinic/Center in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2025; 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.