Individual provider Active NPI

Bailley Alexis Danforth, PA-C

  • Physician Assistant
  • Watertown, SD
National Provider Identifier
1184348807
Registry record updated Dec 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1428 Issued in SD
Practice address
506 1St Ave SE
Watertown, SD 57201-4499
Phone
(605) 886-8482
Fax
(605) 884-4300
NPI assigned
Sep 27, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PAC0970 ND
Physician Assistant 363A00000X 1428 SD Primary

Addresses

Primary practice location

506 1St Ave SE
Watertown, SD 57201-4499

Mailing address

506 1St Ave SE
Watertown, SD 57201-4499
Phone (605) 886-8482

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230301000504 SD Practitioner - Physician Assistant 9739557059 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Prairie Lakes Health Care System IncGroup PAC ID 8628987823, 111 clinicians

Practice addresses (Care Compare)

401 9TH Ave NW
Watertown, SD 57201-1548
Phone (605) 882-7000

506 1St Ave SE
Watertown, SD 57201-4402
Phone (605) 886-8482

511 14TH Ave NE
Watertown, SD 57201-6811
Phone (605) 886-8482

Hospital & facility affiliations

  • Prairie Lakes Home Health Home health agency, Watertown, SD, CCN 437019
  • Prairie Lakes Healthcare System, Inc Hospital, Watertown, SD, CCN 430005

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Johnson Memorial Health Services CurrentSince Mar 1, 2023 Accepting new patients
Prairie Lakes Health Care System Inc CurrentSince Jan 1, 2025 Accepting new patients
Prairie Lakes Health Care System Inc Physician Assistant CurrentSince Jan 1, 2025 Accepting new patients
Regional Diagnostic Radiology Current Accepting new patients
Kidney Institute of North Dakota, LLC PastSince Oct 1, 2022 Accepting new patients
Prairie Lakes Health Care System Inc Past Accepting new patients

Locations

401 9th Ave NW
Watertown, SD 57201
Phone (605) 886-9317

506 1st Ave SE
Watertown, SD 57201
Phone (605) 884-4247

511 14th Ave NE
Watertown, SD 57201
Phone (605) 330-9619

Organizations & group practices 7

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

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1664236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702857600000",
    "number": "1184348807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 1ST AVE SE",
            "city": "WATERTOWN",
            "state": "SD",
            "postal_code": "572014499",
            "telephone_number": "605-886-8482",
            "fax_number": "605-884-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 1ST AVE SE",
            "city": "WATERTOWN",
            "state": "SD",
            "postal_code": "572014499",
            "telephone_number": "605-886-8482",
            "fax_number": "605-884-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANFORTH",
        "first_name": "BAILLEY",
        "middle_name": "ALEXIS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-27",
        "last_updated": "2023-12-18",
        "certification_date": "2023-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ND",
            "license": "PAC0970",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SD",
            "license": "1428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, SD

Sources for this page

Verify at the official NPI Registry.