Individual provider Active NPI

Beth A Iverson, CNP

  • Nurse Practitioner
  • Rapid City, SD
National Provider Identifier
1043264146
Registry record updated Dec 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
CP000217 Issued in SD
Practice address
640 Flormann St
Rapid City, SD 57701
Phone
(605) 718-3300
Fax
(605) 718-3426
NPI assigned
May 22, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X CP000217 SD Primary

Addresses

Primary practice location

640 Flormann St
Rapid City, SD 57701

Mailing address

353 Fairmont Blvd
Atten Medical Staff Services
Rapid City, SD 57701-6000

Other identifiers 1

IdentifierTypeStateIssuer
P00358634OtherSDRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050714000332 SD Practitioner - Nurse Practitioner 1052301298 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
217SDMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince Jul 4, 2018 Accepting new patients
Avera McKennan CurrentSince Jul 4, 2018 Accepting new patients
Avera McKennan Current Accepting new patients
Medical Associates of the Black Hillc, LLC. Past Accepting new patients
Dialysis Management Group LLC PastSince Dec 4, 2003 Accepting new patients

Locations

640 Flormann St
Rapid City, SD 57701
Phone (605) 341-3140

640 Flormann St
Ste 100
Rapid City, SD 57701
Phone (605) 718-3100

640 Flormann St
Ste 300
Rapid City, SD 57701
Phone (605) 718-3300

911 E 20th St
Ste 509
Sioux Falls, SD 57105
Phone (605) 322-5800

Interoperability endpoints

  • Direct secure messaging: beth.iverson@avera.sdhealthlink.net

Organizations & group practices 5

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": "1148256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545264000000",
    "number": "1043264146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "353 FAIRMONT BLVD",
            "address_2": "ATTEN MEDICAL STAFF SERVICES",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577016000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 FLORMANN ST",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "57701",
            "telephone_number": "605-718-3300",
            "fax_number": "605-718-3426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVERSON",
        "first_name": "BETH",
        "middle_name": "A",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-22",
        "last_updated": "2018-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SD",
            "license": "CP000217",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00358634",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rapid City, SD

Sources for this page

Verify at the official NPI Registry.