NPIMap

Organization Active NPI

Black Hills Regional Eye Surgery Center, LLC

  • Certified Registered Nurse Anesthetist
  • Rapid City, SD
National Provider Identifier
1174654081
Registry record updated Jul 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
BLACK HILLS REGIONAL EYE SURGERY CENTER, LLC
Practice address
2800 3Rd St
Rapid City, SD 57701-7374
Phone
(605) 341-2000
Fax
(605) 341-0278
NPI assigned
Mar 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2024

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

Authorized official

Name
Jodi Anderson
Title
Chief Financial Officer
Phone
(605) 341-2000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

2800 3Rd St
Rapid City, SD 57701-7374

Mailing address

2800 3Rd St
Rapid City, SD 57701-7374
Phone (605) 341-2000

Other names 1

  • Black Hills Regional Surgery Anesthesia Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040602001563 SD Part B Supplier - Clinic/Group Practice 7113909201 Receives reassigned benefits from 14 practitioners
Practice locations: Rapid City, SD

National Provider Directory

National Provider Directory
Tax ID family
Black Hills Reg Eye Sur2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720656000000",
    "number": "1174654081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 3RD ST",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577017374",
            "telephone_number": "605-341-2000",
            "fax_number": "605-341-0278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 3RD ST",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577017374",
            "telephone_number": "605-341-2000",
            "fax_number": "605-341-0278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK HILLS REGIONAL EYE SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "JODI",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "605-341-2000"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Black Hills Regional Surgery Anesthesia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rapid City, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; 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.