Dr.Jackiegilbertsonllc

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

276 Issued in SD

Legal business name

DR.JACKIEGILBERTSONLLC

Practice address

623 Quincy St
102
Rapid City, SD 57701-8231

Phone

(605) 430-6364

Fax

(605) 716-9491

NPI assigned

Jul 12, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Jackie R Gilbertson, ED.DNPI 1952380289

Title

Psychologistlicensed

Phone

(605) 430-6364

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

Locations

Practitioners 1

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

• Jackie Gilbertson, LICENSED PSYCHOLOGIS

  • Psychologist
  • Rapid City, SD
  • NPI 1952380289
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1342051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342051200000",
    "number": "1124383435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "623 QUINCY ST",
            "address_2": "102",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577018231",
            "telephone_number": "605-430-6364",
            "fax_number": "605-716-9491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "623 QUINCY ST",
            "address_2": "102",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577018231",
            "telephone_number": "605-430-6364",
            "fax_number": "605-716-9491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR.JACKIEGILBERTSONLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-12",
        "last_updated": "2012-07-12",
        "status": "A",
        "authorized_official_last_name": "GILBERTSON",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PSYCHOLOGISTLICENSED",
        "authorized_official_telephone_number": "605-430-6364",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ED.D"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "SD",
            "license": "276",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6551113",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Anthony Doyon, D.P.M.
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• Trudy Agnes Draskovic
• Melissa Rae Drennon, RDH
• Marianne Drobny, PT

• Community/Behavioral Health Agency in Rapid City, SD
• Providers in Rapid City, SD by specialty
• Community/Behavioral Health Agency in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.