Active NPI
Mary R. Ingram, FNP
- Nurse Practitioner
- Rapid City, SD
National Provider Identifier
1164486452
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- RPO22257
- Practice address
- 3200 Canyon Lake Dr
Rapid City, SD 57702-8114 - Phone
- (605) 355-2443
- Fax
- (605) 355-2403
- NPI assigned
- Apr 13, 2006
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | RPO22257 | SD | Primary |
Addresses
Primary practice location
3200 Canyon Lake Dr
Rapid City, SD 57702-8114
Mailing address
3200 Canyon Lake Dr
Rapid City, SD 57702-8114
Phone (605) 355-2443
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5549050 | 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPO22257 | SD | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320710400000",
"number": "1164486452",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3200 CANYON LAKE DR",
"city": "RAPID CITY",
"state": "SD",
"postal_code": "577028114",
"telephone_number": "605-355-2443",
"fax_number": "605-355-2403"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3200 CANYON LAKE DR",
"city": "RAPID CITY",
"state": "SD",
"postal_code": "577028114",
"telephone_number": "605-355-2443",
"fax_number": "605-355-2403"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INGRAM",
"first_name": "MARY",
"middle_name": "R.",
"name_prefix": "Ms.",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-13",
"last_updated": "2011-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "SD",
"license": "RPO22257",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5549050",
"state": "SD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rapid City, SD
- Indian Health Service
- Individual and Family Counseling
- Infinity Eyecare, PC
- Infinity Implant and Sedation Dentistry Black Hills LLC
- Kathleen R Ingle, FNP
- Innovative Bracing Concepts, LLC
- Integrate Wellness LLC
- Integrated Eye Care Prof. LLC
- Interior West Counseling L.L.C.
- Internal Medicine and Geriatrics Associates, LLP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.