Active NPI
Beverly J Gunderson, ED.D.
- Clinical Child & Adolescent Psychologist
- Sioux Falls, SD
National Provider Identifier
1124090642
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 195
- Practice address
- 4400 W 69TH St
Ste 1500
Sioux Falls, SD 57108-8170 - Phone
- (605) 322-5700
- Fax
- (605) 322-5704
- NPI assigned
- Feb 7, 2006
- Last updated
- Oct 11, 2018
- 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 |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | 195 | SD | Primary |
Addresses
Primary practice location
4400 W 69TH St
Ste 1500
Sioux Falls, SD 57108-8170
Mailing address
PO Box 86370
Sioux Falls, SD 57118-6370
Phone (605) 322-7510
Other identifiers 17
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 680015878 | Other | SD | RR MEDICARE |
| P195 | Other | SD | DAKOTACARE |
| 12200 | Medicaid | ND | |
| 412991028090 | Other | SD | PREFERRED ONE |
| 581816800 | Medicaid | MN | |
| 596332 | Other | SD | ARAZ/ AMERICA'S PPO |
| 040121002 | Other | MN | PRIMEWEST |
| 10635 | Other | SD | MIDLANDS CHOICE |
| 57108C025 | Other | SD | WPS TRICARE |
| 46022474352 | Medicaid | NE | |
| 0040485 | Other | SD | BLUE CROSS |
| 141M3GU | Other | MN | CC SYSTEMS/ BLUE PLUS |
| 3989442 | Medicaid | IA | |
| 122288 | Other | MN | UCARE |
| 28142 | Other | SD | SANFORD HEALTH PLAN |
| HP24855 | Other | SD | HEALTPARTNERS |
| 6550806 | Medicaid | SD |
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
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University Physician | Past | Accepting new patients |
Interoperability endpoints
- beverly.gunderson@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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Family Medicine Physician
- Sioux Falls, SD
- NPI 1942236096
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": "1539216000000",
"number": "1124090642",
"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": "4400 W 69TH ST",
"address_2": "STE 1500",
"city": "SIOUX FALLS",
"state": "SD",
"postal_code": "571088170",
"telephone_number": "605-322-5700",
"fax_number": "605-322-5704"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUNDERSON",
"first_name": "BEVERLY",
"middle_name": "J",
"credential": "ED.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-07",
"last_updated": "2018-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "SD",
"license": "195",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "680015878",
"state": "SD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DAKOTACARE",
"identifier": "P195",
"state": "SD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "12200",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "412991028090",
"state": "SD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "581816800",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ARAZ/ AMERICA'S PPO",
"identifier": "596332",
"state": "SD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRIMEWEST",
"identifier": "040121002",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MIDLANDS CHOICE",
"identifier": "10635",
"state": "SD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WPS TRICARE",
"identifier": "57108C025",
"state": "SD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "46022474352",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "0040485",
"state": "SD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CC SYSTEMS/ BLUE PLUS",
"identifier": "141M3GU",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3989442",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "122288",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SANFORD HEALTH PLAN",
"identifier": "28142",
"state": "SD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTPARTNERS",
"identifier": "HP24855",
"state": "SD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6550806",
"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 11, 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.