NPIMap

Individual provider Active NPI

Ricky Kooima, M.D.

  • Pediatrics Physician
  • Sioux Falls, SD
National Provider Identifier
1093750283
Registry record updated Apr 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
4499 Issued in SD
Practice address
1200 S 7TH Ave
Sioux Falls, SD 57105-0900
Phone
(605) 336-2140
Fax
(605) 336-1677
NPI assigned
Jun 19, 2006
Last updated
Apr 18, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 4499 SD Primary

Addresses

Primary practice location

1200 S 7TH Ave
Sioux Falls, SD 57105-0900

Mailing address

1200 S 7TH Ave
Sioux Falls, SD 57105-0900
Phone (605) 504-5400

Other identifiers 1

IdentifierTypeStateIssuer
6700252MedicaidSD

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
I20051219000376 SD Practitioner - Pediatric Medicine 5698662567 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
University of Iowa, RJ & L Carver College of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera McKennanGroup PAC ID 0345157103, 957 clinicians

Practice addresses (Care Compare)

1200 S 7TH Ave
Sioux Falls, SD 57105-0900
Phone (605) 336-2140

1910 W 69TH St
Sioux Falls, SD 57108-5612
Phone (605) 322-5200

740 S Hill St
Salem, SD 57058-8760
Phone (605) 425-2855

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4499SDMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince Jul 1, 2014 Accepting new patients
Avera McKennan Pediatrics CurrentSince Jun 1, 2017 Accepting new patients
Avera McKennan Current Accepting new patients
Avera McKennan Past Accepting new patients

Locations

1200 S 7th Ave
Sioux Falls, SD 57105
Phone (605) 336-2140

Interoperability endpoints

  • Direct secure messaging: rick.kooima@avera.sdhealthlink.net

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Freeman Regional Health ServicesMenno, SD, CCN 433444 Rural health clinic Corporate Director Oct 1, 2014
Freeman Regional Health ServicesBridgewater, SD, CCN 433443 Rural health clinic Corporate Director Oct 1, 2014
Freeman Regional Health ServicesMarion, SD, CCN 433445 Rural health clinic Corporate Director Oct 1, 2014

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

  • Avera McKennan

    dba Avera McKennan Behavioral Health Clinic

    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Sioux Falls, SD
    • NPI 1699009944
    Medicare reassignment Care Compare group NPD
  • Avera McKennan

    dba Avera Interventional Radiology

    • Diagnostic Radiology Physician
    • Sioux Falls, SD
    • NPI 1053680678
    NPD
  • Avera McKennan

    dba Avera Medical Group

    • Family Medicine Physician
    • Sioux Falls, SD
    • NPI 1376575514

    Pediatrics

    NPD
  • Avera McKennan

    dba Avera McKennan Hospital and University Health Center

    • General Acute Care Hospital
    • Sioux Falls, SD
    • NPI 1568460772
    NPD (past)

Hospital & facility affiliations 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650240000000",
    "number": "1093750283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 S 7TH AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571050900",
            "telephone_number": "605-504-5400",
            "fax_number": "605-504-5150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 S 7TH AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571050900",
            "telephone_number": "605-336-2140",
            "fax_number": "605-336-1677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOOIMA",
        "first_name": "RICKY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-19",
        "last_updated": "2022-04-18",
        "certification_date": "2022-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SD",
            "license": "4499",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6700252",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.