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Individual provider Active NPI

Gregory Kent Nissen

  • Vascular Surgery Physician
  • Sioux Falls, SD
National Provider Identifier
1174813729
Registry record updated Aug 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
10915 Issued in SD
Practice address
3801 S Elmwood Ave
Sioux Falls, SD 57105-6565
Phone
(605) 306-6140
Fax
(605) 306-6500
NPI assigned
Apr 17, 2011
Last updated
Aug 7, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X 10915 SD Primary

Addresses

Primary practice location

3801 S Elmwood Ave
Sioux Falls, SD 57105-6565

Mailing address

3801 S Elmwood Ave
Sioux Falls, SD 57105-6565
Phone (605) 306-6100

Other practice location 1

1305 W 18th St
Sioux Falls, SD 57105-0401
Phone (605) 312-7300

Other practice location 2

University Of Alabama Birmingham
1808 7th Avenue South, BDB 503
Birmingham, AL 35294-0001
Phone (205) 934-2006

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address gnissen@dakotavascular.com

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
I20181109001004 SD Practitioner - Vascular Surgery 3072756048 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
University of Nebraska College of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dakota Vascular Prof LLCGroup PAC ID 9931588399, 6 clinicians

Practice addresses (Care Compare)

3801 S Elmwood Ave
Sioux Falls, SD 57105-6565
Phone (605) 306-6100

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal93
Leg revascularization (restoring blood flow)73
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10915SDMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dakota Vascular Prof LLC Vascular Surgery CurrentSince Aug 1, 2022 Accepting new patients

Locations

110 S Logan Ave
Gregory, SD 57533
Phone (605) 655-1220

111 4th St SE
Huron, SD 57350
Phone (605) 352-8691

525 N Foster St
Mitchell, SD 57301
Phone (605) 995-2000

818 W Havens Ave
Mitchell, SD 57301
Phone (605) 996-7526

401 W Glynn Dr
Parkston, SD 57366
Phone (605) 928-3311

3801 S Elmwood Ave
Sioux Falls, SD 57105
Phone (605) 336-3142

745 E 8th St
Winner, SD 57580
Phone (605) 842-2626

Organizations & group practices 1

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 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1302998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659830400000",
    "number": "1174813729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 S ELMWOOD AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571056565",
            "telephone_number": "605-306-6100",
            "fax_number": "605-306-6500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 S ELMWOOD AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571056565",
            "telephone_number": "605-306-6140",
            "fax_number": "605-306-6500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1305 W 18th St",
            "address_purpose": "LOCATION",
            "city": "Sioux Falls",
            "state": "SD",
            "postal_code": "571050401",
            "country_code": "US",
            "telephone_number": "605-312-7300",
            "fax_number": "605-312-7301",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "University Of Alabama Birmingham",
            "address_2": "1808 7th Avenue South, BDB 503",
            "address_purpose": "LOCATION",
            "city": "Birmingham",
            "state": "AL",
            "postal_code": "352940001",
            "country_code": "US",
            "telephone_number": "205-934-2006",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NISSEN",
        "first_name": "GREGORY",
        "middle_name": "KENT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-17",
        "last_updated": "2022-08-07",
        "certification_date": "2022-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "SD",
            "license": "10915",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gnissen@dakotavascular.com",
            "affiliation": "N",
            "address_1": "3801 S Elmwood Ave",
            "city": "Sioux Falls",
            "state": "SD",
            "country_code": "US",
            "postal_code": "571056565",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.