NPIMap

Individual provider Active NPI

Amy St Aubin, NP-C

  • Nurse Practitioner
  • Sioux Falls, SD
National Provider Identifier
1184976979
Registry record updated Feb 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
F0912512 Issued in MN
Practice address
1417 S. Cliff Ave.
Suite 401
Sioux Falls, SD 57105-1064
Phone
(605) 322-8920
Fax
(605) 322-8919
NPI assigned
Oct 4, 2012
Last updated
Feb 10, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X F0912512 MN Primary

Addresses

Primary practice location

1417 S. Cliff Ave.
Suite 401
Sioux Falls, SD 57105-1064

Mailing address

2400 S. Minnesota Ave.
Suite 100
Sioux Falls, SD 57105-3762
Phone (605) 322-7510

Other identifiers 1

IdentifierTypeStateIssuer
6831470MedicaidSD

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
I20130807001062 SD Practitioner - Nurse Practitioner 1355595323 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera McKennanGroup PAC ID 0345157103, 957 clinicians

Practice addresses (Care Compare)

1000 E 23Rd St
Sioux Falls, SD 57105-2140

1001 E 21St St
Suite 401
Sioux Falls, SD 57105-1017
Phone (605) 322-8920

1325 S Cliff Ave
Sioux Falls, SD 57105-1007

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F0912512MNMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince Aug 10, 2013 Accepting new patients
Avera McKennan Current Accepting new patients
Avera McKennan CurrentSince Aug 10, 2013 Accepting new patients
Avera McKennan Nurse Practitioner Past Accepting new patients

Locations

1200 S 7th Ave
Sioux Falls, SD 57105
Phone (605) 336-2140

1417 S Cliff Ave
Ste 401
Sioux Falls, SD 57105
Phone (605) 322-8920

2100 S Marion Rd
Ste 300
Sioux Falls, SD 57106
Phone (605) 322-1300

Interoperability endpoints

  • Direct secure messaging: amy.st.aubin@avera.sdhealthlink.net

Organizations & group practices 4

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.

  • Avera McKennan

    dba Avera McKennan Behavioral Health Clinic

    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Sioux Falls, SD
    • NPI 1699009944
    Medicare reassignment Care Compare group NPD
  • Avera McKennan

    dba Avera Interventional Radiology

    • Diagnostic Radiology Physician
    • Sioux Falls, SD
    • NPI 1053680678
    NPD
  • Avera McKennan

    dba Avera Medical Group Gynecologic Oncology Sioux Falls

    • Gynecologic Oncology Physician
    • Sioux Falls, SD
    • NPI 1932346251
    NPD
  • Avera McKennan

    dba Avera Medical Group

    • Family Medicine Physician
    • Sioux Falls, SD
    • NPI 1376575514

    Nurse Practitioner

    NPD (past)

Hospital & facility affiliations 29

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

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1349308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486684800000",
    "number": "1184976979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 S. MINNESOTA AVE.",
            "address_2": "SUITE 100",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571053762",
            "telephone_number": "605-322-7510",
            "fax_number": "605-322-4995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1417 S. CLIFF AVE.",
            "address_2": "SUITE 401",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051064",
            "telephone_number": "605-322-8920",
            "fax_number": "605-322-8919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ST AUBIN",
        "first_name": "AMY",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-04",
        "last_updated": "2017-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "F0912512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6831470",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.