Active NPI
Dewey J. Ertz, ED.D.
- Psychologist
- Rapid City, SD
National Provider Identifier
1164606570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 123
- Practice address
- 3601 Canyon Lake Dr
Rapid City, SD 57702-3900 - Phone
- (605) 341-8647
- Fax
- (605) 341-0489
- NPI assigned
- Dec 20, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 9
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 123 | SD | |
| Psychologist | 103T00000X | 123 | SD | Primary |
| Clinical Psychologist | 103TC0700X | 123 | SD | |
| Family Psychologist | 103TF0000X | 123 | SD | |
| Forensic Psychologist | 103TF0200X | 123 | SD | |
| Intellectual & Developmental Disabilities Psychologist | 103TM1800X | 123 | SD | |
| Group Psychotherapy Psychologist | 103TP2701X | 123 | SD | |
| Rehabilitation Psychologist | 103TR0400X | 123 | SD | |
| School Psychologist | 103TS0200X | 29664-02 | SD |
Addresses
Primary practice location
3601 Canyon Lake Dr
Rapid City, SD 57702-3900
Mailing address
3601 Canyon Lake Dr
Rapid City, SD 57702-3900
Phone (605) 341-8647
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6550193 | Medicaid | SD | |
| 460461452-26 | Medicaid | NE |
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 |
|---|---|---|---|
| 123 | SD | MD | Forensic Psychologist |
| 29664-02 | SD | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1198108800000",
"number": "1164606570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3601 CANYON LAKE DR",
"city": "RAPID CITY",
"state": "SD",
"postal_code": "577023900",
"telephone_number": "605-341-8647",
"fax_number": "605-341-0489"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3601 CANYON LAKE DR",
"city": "RAPID CITY",
"state": "SD",
"postal_code": "577023900",
"telephone_number": "605-341-8647",
"fax_number": "605-341-0489"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ERTZ",
"first_name": "DEWEY",
"middle_name": "J.",
"name_prefix": "Dr.",
"credential": "ED.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-12-20",
"last_updated": "2007-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "SD",
"license": "123",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "SD",
"license": "123",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "SD",
"license": "123",
"primary": false
},
{
"code": "103TF0000X",
"taxonomy_group": "",
"desc": "Psychologist, Family",
"state": "SD",
"license": "123",
"primary": false
},
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "SD",
"license": "123",
"primary": false
},
{
"code": "103TM1800X",
"taxonomy_group": "",
"desc": "Psychologist, Intellectual & Developmental Disabilities",
"state": "SD",
"license": "123",
"primary": false
},
{
"code": "103TP2701X",
"taxonomy_group": "",
"desc": "Psychologist, Group Psychotherapy",
"state": "SD",
"license": "123",
"primary": false
},
{
"code": "103TR0400X",
"taxonomy_group": "",
"desc": "Psychologist, Rehabilitation",
"state": "SD",
"license": "123",
"primary": false
},
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "SD",
"license": "29664-02",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6550193",
"state": "SD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "460461452-26",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rapid City, SD
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- Es SD Victorian LLC (The Victorian)
- Esl SD Victorian Operations LLC (The Victorian)
- Essilor Laboratories of America, Inc (Twin City Optical)
- Eternal Vision, P.C. (Pearle Vision)
- Anissa Evans Jepsen, EDD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.