NPIMap

Individual provider Active NPI

Mark Adam Travnicek, M.D.

  • Anesthesiology Physician
  • Rapid City, SD
National Provider Identifier
1154552586
Registry record updated Dec 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
52334 Issued in CO
Practice address
353 Fairmont Blvd
Rapid City, SD 57701-7375
Phone
(605) 343-1333
Fax
(605) 343-6017
NPI assigned
Aug 3, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 52334 CO Primary

Addresses

Primary practice location

353 Fairmont Blvd
Rapid City, SD 57701-7375

Mailing address

PO Box 2760
Rapid City, SD 57709-2760
Phone (605) 343-1333

Other practice location 1

1100 E 26th St
Sioux Falls, SD 57105
Phone (605) 338-7098

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
I20181226001480 SD Practitioner - Anesthesiology 1759521966 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
West River Anesthesiology Consultants PCGroup PAC ID 7810989100, 14 clinicians

Practice addresses (Care Compare)

353 Fairmont Blvd
Rapid City, SD 57701-7375
Phone (605) 755-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
52334COMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Avera St. Luke'S Current Accepting new patients
Avera St. Luke'S CurrentSince May 13, 2022 Accepting new patients
Avera St. Lukes CurrentSince May 13, 2022 Accepting new patients
Anesthesiology Associates, Inc. CurrentSince Dec 1, 2018 Accepting new patients
West River Anesthesiology Consultants PC Anesthesiology CurrentSince Feb 1, 2021 Accepting new patients
Anesthesiology Associates Past Accepting new patients

Locations

353 Fairmont Blvd
Rapid City, SD 57701
Phone (605) 719-1000

910 E 20th St
Sioux Falls, SD 57105
Phone (602) 338-7098

1100 E 26th St
Sioux Falls, SD 57105
Phone (605) 338-7098

Organizations & group practices 6

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.

Hospital & facility affiliations 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1249257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608595200000",
    "number": "1154552586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2760",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577092760",
            "telephone_number": "605-343-1333",
            "fax_number": "605-343-6017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "353 FAIRMONT BLVD",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577017375",
            "telephone_number": "605-343-1333",
            "fax_number": "605-343-6017"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 E 26th St",
            "address_purpose": "LOCATION",
            "city": "Sioux Falls",
            "state": "SD",
            "postal_code": "57105",
            "country_code": "US",
            "telephone_number": "605-338-7098",
            "fax_number": "605-335-3505",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TRAVNICEK",
        "first_name": "MARK",
        "middle_name": "ADAM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-03",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CO",
            "license": "52334",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rapid City, SD

Sources for this page

Verify at the official NPI Registry.