NPIMap

Individual provider Active NPI

Nimal Joe Ponnezhan, M.D.

  • Student in an Organized Health Care Education/Training Program
  • Sioux Falls, SD
National Provider Identifier
1083975650
Registry record updated May 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1400 W. 22ND Street
Sioux Falls, SD 57105-1570
Phone
(605) 357-1557
NPI assigned
May 31, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

1400 W. 22ND Street
Sioux Falls, SD 57105-1570

Mailing address

15805 Peggy LN
Apt # 208
Oak Forest, IL 60452-5112
Phone (312) 344-0482

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
I20161208001837 SD Practitioner - Internal Medicine 9537391560 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2012
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

300 W 5TH St
Miller, SD 57362-1238
Phone (605) 853-0158

901 E Virgil Ave
Milbank, SD 57252-2124
Phone (605) 432-4538

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Sacred Heart Health Services Current Accepting new patients
Sacred Heart Health Services CurrentSince Dec 21, 2021 Accepting new patients
Sacred Heart Health Services CurrentSince Dec 21, 2021 Accepting new patients
Avera McKennan Current Accepting new patients
Avera McKennan CurrentSince Jul 1, 2024 Accepting new patients
Avera McKennan CurrentSince Jul 1, 2024 Accepting new patients
Avera McKennan Past Accepting new patients

Locations

300 W 5th St
Miller, SD 57362
Phone (605) 853-0158

501 Summit St
Yankton, SD 57078
Phone (605) 655-1201

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 and National Provider Directory roles.

Hospital & facility affiliations 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1338422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338422400000",
    "number": "1083975650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15805 PEGGY LN",
            "address_2": "APT # 208",
            "city": "OAK FOREST",
            "state": "IL",
            "postal_code": "604525112",
            "telephone_number": "312-344-0482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 W. 22ND STREET",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051570",
            "telephone_number": "605-357-1557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONNEZHAN",
        "first_name": "NIMAL",
        "middle_name": "JOE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-31",
        "last_updated": "2012-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.