NPIMap

Organization Active NPI

Rushmore Clinic, P.C.

  • Internal Medicine Physician
  • Rapid City, SD
National Provider Identifier
1124184510
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
1584 Issued in SD
Legal business name
RUSHMORE CLINIC, P.C.
Practice address
101 E Minnesota St
Suite 260
Rapid City, SD 57701-7756
Phone
(605) 718-7450
Fax
(605) 718-7465
NPI assigned
Dec 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Vicky L Krause
Title
Clinic Manager
Phone
(605) 718-7450

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 1584 SD Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X 0348 SD

Addresses

Primary practice location

101 E Minnesota St
Suite 260
Rapid City, SD 57701-7756

Mailing address

101 E Minnesota St
Suite 260
Rapid City, SD 57701-7756
Phone (605) 718-7450

Other identifiers 7

IdentifierTypeStateIssuer
3522835001OtherOWCP
40192OtherSDSECURE HORIZONS
2944830OtherWYWY WORKERS SAFETY
0040192OtherSDBLUE CROSS BLUE SHIELD
10025296700MedicaidNE
9202253OtherSDCAREWEST
9202253OtherSDDAKOTACARE

National Provider Directory

National Provider Directory

Locations

640 Flormann St
Ste 303
Rapid City, SD 57701
Phone (605) 718-7450

101 E Minnesota St
Ste 260
Rapid City, SD 57701
Phone (605) 484-1616

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1124184510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E MINNESOTA ST",
            "address_2": "SUITE 260",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577017756",
            "telephone_number": "605-718-7450",
            "fax_number": "605-718-7465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E MINNESOTA ST",
            "address_2": "SUITE 260",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577017756",
            "telephone_number": "605-718-7450",
            "fax_number": "605-718-7465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSHMORE CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "KRAUSE",
        "authorized_official_first_name": "VICKY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "605-718-7450"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "SD",
            "license": "1584",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "SD",
            "license": "0348",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OWCP",
            "identifier": "3522835001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SECURE HORIZONS",
            "identifier": "40192",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WY WORKERS SAFETY",
            "identifier": "2944830",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0040192",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025296700",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREWEST",
            "identifier": "9202253",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAKOTACARE",
            "identifier": "9202253",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rapid City, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.