Active NPI
Shannon Lynn Backstrom, CNP
- Perinatal Nurse Practitioner
- Sioux Falls, SD
National Provider Identifier
1093787616
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Perinatal Nurse Practitioner
- License
- CP000442
- Practice address
- 1417 S. Cliff Ave.
Ste. 100
Sioux Falls, SD 57105-1063 - Phone
- (605) 322-8937
- Fax
- (605) 322-8938
- NPI assigned
- Feb 7, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Perinatal Nurse Practitioner | 363LP1700X | CP000442 | SD | Primary |
Addresses
Primary practice location
1417 S. Cliff Ave.
Ste. 100
Sioux Falls, SD 57105-1063
Mailing address
PO Box 86370
Sioux Falls, SD 57118-6370
Phone (605) 322-7510
Other identifiers 17
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2387949 | Other | SD | ARAZ/ AMERICA'S PPO |
| 400070600 | Medicaid | MN | |
| 83G56BE | Other | MN | CC SYSTEMS/ BLUE PLUS |
| 283761045259 | Other | SD | PREFERRED ONE |
| 9244760 | Other | SD | DAKOTACARE |
| HP55697 | Other | SD | HEALTHPARTNERS |
| 0407827 | Other | SD | MEDICA |
| 0503706 | Medicaid | IA | |
| 57105AD05 | Other | SD | WPS TRICARE |
| 6828300 | Medicaid | SD | |
| 10025040700 | Medicaid | NE | |
| 248007 | Other | SD | BLUE CROSS |
| 370624200 | Other | SD | DEPT OF LABOR |
| 6828302 | Medicaid | SD | |
| 83G56BE | Other | MN | BLUE CROSS |
| 924114229808 | Other | MN | PRIMEWEST |
| 248007 | Other | SD | MIDLANDS CHOICE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Avera McKennan | Past | Accepting new patients |
Interoperability endpoints
- shannon.backstrom@avera.sdhealthlink.net
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Sioux Falls, SD
- NPI 1376575514
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539129600000",
"number": "1093787616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 86370",
"city": "SIOUX FALLS",
"state": "SD",
"postal_code": "571186370",
"telephone_number": "605-322-7510",
"fax_number": "605-322-6475"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1417 S. CLIFF AVE.",
"address_2": "STE. 100",
"city": "SIOUX FALLS",
"state": "SD",
"postal_code": "571051063",
"telephone_number": "605-322-8937",
"fax_number": "605-322-8938"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACKSTROM",
"first_name": "SHANNON",
"middle_name": "LYNN",
"credential": "CNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-07",
"last_updated": "2018-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "363LP1700X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Perinatal",
"state": "SD",
"license": "CP000442",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ARAZ/ AMERICA'S PPO",
"identifier": "2387949",
"state": "SD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "400070600",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CC SYSTEMS/ BLUE PLUS",
"identifier": "83G56BE",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "283761045259",
"state": "SD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DAKOTACARE",
"identifier": "9244760",
"state": "SD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "HP55697",
"state": "SD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "0407827",
"state": "SD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0503706",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WPS TRICARE",
"identifier": "57105AD05",
"state": "SD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6828300",
"state": "SD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10025040700",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "248007",
"state": "SD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPT OF LABOR",
"identifier": "370624200",
"state": "SD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6828302",
"state": "SD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "83G56BE",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRIMEWEST",
"identifier": "924114229808",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MIDLANDS CHOICE",
"identifier": "248007",
"state": "SD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sioux Falls, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.