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Individual provider Active NPI

Wyatt Knobloch

  • Family Nurse Practitioner
  • Sioux Falls, SD
National Provider Identifier
1043966914
Registry record updated Mar 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
CP002316 Issued in SD
Practice address
1315 S Cliff Ave Ste 2000
Sioux Falls, SD 57105-1058
Phone
(605) 322-5800
NPI assigned
Mar 1, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X CP002316 SD Primary

Addresses

Primary practice location

1315 S Cliff Ave Ste 2000
Sioux Falls, SD 57105-1058

Mailing address

1315 S Cliff Ave Ste 2000
Sioux Falls, SD 57105-1058

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220329002045 SD Practitioner - Nurse Practitioner 8921494030 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera McKennanGroup PAC ID 0345157103, 957 clinicians

Practice addresses (Care Compare)

1325 S Cliff Ave
Sioux Falls, SD 57105-1007

310 22ND Ave
Brookings, SD 57006-2474

4500 W 69TH St
Sioux Falls, SD 57108-8148
Phone (605) 322-9777

4520 W 69TH St
Sioux Falls, SD 57108-8148
Phone (605) 977-5000

Hospital & facility affiliations

  • Avera McKennan Hospital & University Health Center Hospital, Sioux Falls, SD, CCN 430016
  • Avera Heart Hospital of South Dakota Hospital, Sioux Falls, SD, CCN 430095

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
CP002316SDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan Current Accepting new patients
Avera McKennan CurrentSince Mar 7, 2022 Accepting new patients
Avera McKennan CurrentSince Mar 7, 2022 Accepting new patients
Avera McKennan Past Accepting new patients

Locations

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

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

1315 S Cliff Ave
Ste 2000
Sioux Falls, SD 57105
Phone (605) 322-5800

Interoperability endpoints

  • Direct secure messaging: wyatt.knobloch@avera.sdhealthlink.net

Organizations & group practices 4

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.

Hospital & facility affiliations 25

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

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1646092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647820800000",
    "number": "1043966914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1315 S CLIFF AVE STE 2000",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 S CLIFF AVE STE 2000",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051058",
            "telephone_number": "605-322-5800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNOBLOCH",
        "first_name": "WYATT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-01",
        "last_updated": "2022-03-21",
        "certification_date": "2022-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SD",
            "license": "CP002316",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.