NPIMap

Individual provider Active NPI

Amanda Louise Fellbaum, CNP

  • Adult Health Nurse Practitioner
  • Sioux Falls, SD
National Provider Identifier
1083377584
Registry record updated May 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
CP002165 Issued in SD
Practice address
1112 S Lake Avenue Suite 201
Sioux Falls, SD 57104
Phone
(605) 312-5350
Fax
(605) 312-8928
NPI assigned
Oct 21, 2021
Last updated
May 23, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X CP002165 SD Primary

Addresses

Primary practice location

1112 S Lake Avenue Suite 201
Sioux Falls, SD 57104

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074
Phone (605) 312-5350

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.sanfordhealth.org/locations/sanford-health-post-acute-community-services-clinic Direct

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
I20220414000967 SD Practitioner - Nurse Practitioner 9739575036 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sanford Medical CenterGroup PAC ID 8325950215, 847 clinicians

Practice addresses (Care Compare)

3401 W 49TH St
Sioux Falls, SD 57106-2322
Phone (605) 328-1850

4405 E 26TH St
Sioux Falls, SD 57103-4187
Phone (605) 332-2883

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.78 of 100Reported as group
Quality
78.77
Promoting interoperability
100
Improvement activities
40
Cost
70.49

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center CurrentSince Dec 1, 2022 Accepting new patients
Sanford Clinic CurrentSince Jan 4, 2022 Accepting new patients
Sanford Clinic Current Accepting new patients
Sanford Clinic CurrentSince Oct 24, 2021 Accepting new patients
Sanford Clinic CurrentSince Jan 4, 2022 Accepting new patients
Sanford Clinic Past Accepting new patients
Sanford Clinic Past Accepting new patients

Locations

4405 E 26th St
Sioux Falls, SD 57103
Phone (605) 328-9000

901 4th St NW
Watertown, SD 57201
Phone (605) 882-8780

Organizations & group practices 7

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 3

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": "1634774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653264000000",
    "number": "1083377584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074",
            "telephone_number": "605-312-5350",
            "fax_number": "605-312-8928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1112 S LAKE AVENUE SUITE 201",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "57104",
            "telephone_number": "605-312-5350",
            "fax_number": "605-312-8928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FELLBAUM",
        "first_name": "AMANDA",
        "middle_name": "LOUISE",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-21",
        "last_updated": "2022-05-23",
        "certification_date": "2022-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "SD",
            "license": "CP002165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.sanfordhealth.org/locations/sanford-health-post-acute-community-services-clinic",
            "affiliation": "N",
            "endpointDescription": "Clinic website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Clinic website",
            "address_1": "1112 S Lake Avenue Suite 201",
            "city": "Sioux Falls",
            "state": "SD",
            "country_code": "US",
            "postal_code": "57104",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.