NPIMap

Individual provider Active NPI

Michael Statz

  • Surgery Physician
  • Rapid City, SD
National Provider Identifier
1174550628
Registry record updated Nov 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
2772 Issued in SD
Practice address
2820 Mount Rushmore Rd
Rapid City, SD 57701-5462
Phone
(605) 342-3280
NPI assigned
Jun 27, 2006
Last updated
Nov 5, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 2772 SD Primary

Addresses

Primary practice location

2820 Mount Rushmore Rd
Rapid City, SD 57701-5462

Mailing address

2820 Mount Rushmore Rd
Rapid City, SD 57701-5462

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
I20100322000104 SD Practitioner - General Surgery 9234146580 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Creighton University School of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Black Hills Surgical Hospital LLCGroup PAC ID 5496742835, 173 clinicians

Practice addresses (Care Compare)

216 Anamaria Dr
Rapid City, SD 57701-7366
Phone (605) 791-7777

353 Fairmont Blvd
Rapid City, SD 57701-7375
Phone (605) 755-8109

651 Cathedral Dr
Rapid City, SD 57701-7368
Phone (307) 670-9150

7236 Jordan Dr
Rapid City, SD 57702-8740
Phone (605) 508-3000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)12
Hernia repair (minimally invasive)12
Mastectomy1-10
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Monument Health Rapid City Hospital, Inc. CurrentSince Feb 1, 2024 Accepting new patients
Monument Health Rapid City Hospital Inc CurrentSince Feb 1, 2024 Accepting new patients
Monument Health Rapid City Hospital, Inc Current Accepting new patients
Rapid City Medical Center, LLP Current Accepting new patients
Regional Health Physicians Inc PastSince Jun 22, 2011 Accepting new patients
Rapid City Indian Health Service Hospital Past Accepting new patients
Monument Health Rapid City Hospital, Inc. Past Accepting new patients

Locations

2820 Mount Rushmore Rd
Rapid City, SD 57701
Phone (605) 721-8121

2820 Mount Rushmore Rd
#0
Rapid City, SD 57701

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

1124 Washington Blvd
Newcastle, WY 82701
Phone (307) 746-3715

Interoperability endpoints

  • Direct secure messaging: michael.statz@rcmc.eclinicaldirectplus.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Monument Health Wall ClinicWall, SD, CCN 433802 Rural health clinic Corporate Director Jun 27, 2019

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194220800000",
    "number": "1174550628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2820 MOUNT RUSHMORE RD",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577015462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2820 MOUNT RUSHMORE RD",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577015462",
            "telephone_number": "605-342-3280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STATZ",
        "first_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-27",
        "last_updated": "2007-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "SD",
            "license": "2772",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rapid City, SD

Sources for this page

Verify at the official NPI Registry.