NPIMap

Organization Active NPI

Brookings Neuropsychology Services

  • Clinical Neuropsychologist
  • Brookings, SD
National Provider Identifier
1023368016
Registry record updated Sep 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
472 Issued in SD
Legal business name
BROOKINGS NEUROPSYCHOLOGY SERVICES
Practice address
928 4TH St
Suite 6
Brookings, SD 57006-2171
Phone
(605) 692-6367
Fax
(605) 692-1883
NPI assigned
Sep 17, 2012
Last updated
Sep 17, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2012

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

Authorized official

Name
Dr. Thomas Rauby Shaffer, PHDNPI 1770749442
Title
Clinic Manager
Phone
(605) 692-6367

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103G00000X 472 SD Primary

Addresses

Primary practice location

928 4TH St
Suite 6
Brookings, SD 57006-2171

Mailing address

PO Box 931
Brookings, SD 57006-0931
Phone (605) 692-6367

Other identifiers 2

IdentifierTypeStateIssuer
6552660MedicaidSD
S102729OtherMEDICARE PTAN/ID

National Provider Directory

National Provider Directory

Locations

928 4th St
Ste 6
Brookings, SD 57006
Phone (605) 692-6367

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1347840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347840000000",
    "number": "1023368016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 931",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "570060931",
            "telephone_number": "605-692-6367",
            "fax_number": "605-692-1883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "928 4TH ST",
            "address_2": "SUITE 6",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "570062171",
            "telephone_number": "605-692-6367",
            "fax_number": "605-692-1883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKINGS NEUROPSYCHOLOGY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-17",
        "last_updated": "2012-09-17",
        "status": "A",
        "authorized_official_last_name": "SHAFFER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "RAUBY",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "605-692-6367",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "SD",
            "license": "472",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6552660",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN/ID",
            "identifier": "S102729",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookings, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2012; 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.