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Individual provider Active NPI

Dominic Shuttleworth, DO

  • Family Medicine Physician
  • Pierre, SD
National Provider Identifier
1215673504
Registry record updated Dec 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
17650 Issued in SD
Practice address
801 E Sioux Ave
Pierre, SD 57501-3323
Phone
(605) 224-3100
NPI assigned
May 9, 2022
Last updated
Dec 24, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 24, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 17650 SD Primary

Addresses

Primary practice location

801 E Sioux Ave
Pierre, SD 57501-3323

Mailing address

204 E Meade St
Rapid City, SD 57701-5658
Phone (907) 978-5614

Other practice location 1

1115 E 20th St
Sioux Falls, SD 57105-1013
Phone (605) 333-1000

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
I20251015001163 SD Practitioner - Family Practice 5294101002 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera St MarysGroup PAC ID 0143134965, 97 clinicians

Practice addresses (Care Compare)

801 E Sioux Ave
Pierre, SD 57501-3323
Phone (605) 224-5901

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
17650SDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Avera Gettysburg CurrentSince Dec 21, 2025 Accepting new patients
Avera St Marys CurrentSince Sep 1, 2025 Accepting new patients
Avera Gettysburg CurrentSince Oct 20, 2025 Accepting new patients
Avera St Marys CurrentSince Sep 1, 2025 Accepting new patients
Avera McKennan Family Medicine Past Accepting new patients

Locations

606 E Garfield Ave
Ste C
Gettysburg, SD 57442
Phone (605) 765-2273

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 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": "1652054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766534400000",
    "number": "1215673504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 E MEADE ST",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577015658",
            "telephone_number": "907-978-5614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 E SIOUX AVE",
            "city": "PIERRE",
            "state": "SD",
            "postal_code": "575013323",
            "telephone_number": "605-224-3100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1115 E 20th St",
            "address_purpose": "LOCATION",
            "city": "Sioux Falls",
            "state": "SD",
            "postal_code": "571051013",
            "country_code": "US",
            "telephone_number": "605-333-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHUTTLEWORTH",
        "first_name": "DOMINIC",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-05-09",
        "last_updated": "2025-12-24",
        "certification_date": "2025-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "17650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pierre, SD

Sources for this page

Verify at the official NPI Registry.