NPIMap

Individual provider Active NPI

Paul M Bommersbach, CRNA

  • Certified Registered Nurse Anesthetist
  • Sioux Falls, SD
National Provider Identifier
1194710939
Registry record updated Aug 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R025403 Issued in SD
Practice address
800 E 21St St
Sioux Falls, SD 57105-1016
Phone
(605) 322-2754
Fax
(605) 322-2727
NPI assigned
Sep 19, 2005
Last updated
Aug 20, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X R025403 SD Primary

Addresses

Primary practice location

800 E 21St St
Sioux Falls, SD 57105-1016

Mailing address

800 E 21St St
Pat Financial Serv.
Sioux Falls, SD 57105-1016
Phone (605) 322-2754

Other identifiers 10

IdentifierTypeStateIssuer
5751466MedicaidSD
005230OtherSDBLUE CROSS OF SD
46022474348MedicaidNE
5751464MedicaidSD
013K4BOOtherMNMN BLUE CROSS BS
2538736MedicaidIA
350443300MedicaidMN
4995505OtherSDWELLMARK
R025403OtherSDDAKOTACARE
1538736MedicaidIA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040426000581 SD Practitioner - Certified Registered Nurse Anesthetist (Crna) 8325034184 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera McKennanGroup PAC ID 0345157103, 957 clinicians

Practice addresses (Care Compare)

1325 S Cliff Ave
Sioux Falls, SD 57105-1007

909 N Iowa Ave
Dell Rapids, SD 57022-1231
Phone (605) 428-5431

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0410SDMDRegistered Dietitian
R025403SDMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Heart Hospital of South Dakota LLC CurrentSince Mar 8, 2004 Accepting new patients
Avera McKennan CurrentSince Dec 12, 1997 Accepting new patients
Heart Hospital of South Dakota LLC CurrentSince Mar 8, 2004 Accepting new patients
Avera McKennan Nurse Anesthetist, Certified Registered CurrentSince Dec 12, 1997 Accepting new patients
Avera McKennan Current Accepting new patients

Locations

909 N Iowa Ave
Dell Rapids, SD 57022
Phone (605) 428-5431

172 4th St SE
Huron, SD 57350
Phone (605) 353-6593

4500 W 69th St
Sioux Falls, SD 57108
Phone (605) 977-7000

800 E 21st St
Sioux Falls, SD 57105
Phone (605) 322-2754

Organizations & group practices 5

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 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1127088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282262400000",
    "number": "1194710939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 E 21ST ST",
            "address_2": "PAT FINANCIAL SERV.",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051016",
            "telephone_number": "605-322-2754",
            "fax_number": "605-322-2727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E 21ST ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051016",
            "telephone_number": "605-322-2754",
            "fax_number": "605-322-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOMMERSBACH",
        "first_name": "PAUL",
        "middle_name": "M",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-19",
        "last_updated": "2010-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "SD",
            "license": "R025403",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5751466",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF SD",
            "identifier": "005230",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "46022474348",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5751464",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN BLUE CROSS BS",
            "identifier": "013K4BO",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2538736",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "350443300",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK",
            "identifier": "4995505",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAKOTACARE",
            "identifier": "R025403",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1538736",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.