NPIMap

Individual provider Active NPI

Darcy J McClelland, PA

  • Physician Assistant
  • Pierre, SD
National Provider Identifier
1124062823
Registry record updated Apr 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0368 Issued in SD
Practice address
100 Mac Lane
Avera Medical Group Pierre
Pierre, SD 57501
Phone
(605) 945-5255
Fax
(605) 945-5295
NPI assigned
Jun 15, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0368 SD Primary

Addresses

Primary practice location

100 Mac Lane
Avera Medical Group Pierre
Pierre, SD 57501

Mailing address

100 Mac Lane
Avera Medical Group Pierre
Pierre, SD 57501
Phone (605) 945-5255

Other identifiers 2

IdentifierTypeStateIssuer
6822680MedicaidSD
6822683MedicaidSD

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
I20050919000749 SD Practitioner - Physician Assistant 7911931035 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
368SDMDClinical Psychologist
0368SDMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince Jan 1, 2009 Accepting new patients
Avera St Marys CurrentSince Mar 1, 2013 Accepting new patients
Avera McKennan CurrentSince Jan 1, 2009 Accepting new patients
Avera St Marys CurrentSince Mar 1, 2013 Accepting new patients
Pediatric Hematology Oncology Pharmacy LTC Past Accepting new patients
Pediatric Hematology Clinic LTD Past Accepting new patients

Locations

100 Mac Ln
Pierre, SD 57501
Phone (605) 224-5901

800 E Dakota Ave
Pierre, SD 57501
Phone (605) 224-3100

Interoperability endpoints

  • Direct secure messaging: darcy.mcclelland@avera.sdhealthlink.net

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334275200000",
    "number": "1124062823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MAC LANE",
            "address_2": "AVERA MEDICAL GROUP PIERRE",
            "city": "PIERRE",
            "state": "SD",
            "postal_code": "57501",
            "telephone_number": "605-945-5255",
            "fax_number": "605-945-5295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MAC LANE",
            "address_2": "AVERA MEDICAL GROUP PIERRE",
            "city": "PIERRE",
            "state": "SD",
            "postal_code": "57501",
            "telephone_number": "605-945-5255",
            "fax_number": "605-945-5295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCLELLAND",
        "first_name": "DARCY",
        "middle_name": "J",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-15",
        "last_updated": "2012-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SD",
            "license": "0368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6822680",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6822683",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pierre, SD

Sources for this page

Verify at the official NPI Registry.