NPIMap

Individual provider Active NPI

Stacie A. Lenssen, MD

  • Family Medicine Physician
  • Watertown, SD
National Provider Identifier
1215994769
Registry record updated May 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5224 Issued in SD
Practice address
506 1St Ave SE
Watertown, SD 57201-4402
Phone
(605) 886-8482
Fax
(605) 884-4300
NPI assigned
Apr 27, 2006
Last updated
May 17, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2022

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 5224 SD Primary

Addresses

Primary practice location

506 1St Ave SE
Watertown, SD 57201-4402

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
5611460MedicaidSD

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
I20031230000779 SD Practitioner - Family Practice 7416855283 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

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

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5224SDMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Brown Clinic PLLP Family Medicine CurrentSince Jul 22, 2003 Accepting new patients
Johnson Memorial Health Services CurrentSince Jul 22, 2003 Accepting new patients
Prairie Lakes Health Care System Inc Family Medicine CurrentSince Jan 1, 2025 Accepting new patients
Regional Diagnostic Radiology Current Accepting new patients
Prairie Lakes Health Care System Inc Family Medicine CurrentSince Jan 1, 2025 Accepting new patients
Prairie Lakes Health Care System Inc Current 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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652745600000",
    "number": "1215994769",
    "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": "572014402",
            "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": "572014402",
            "telephone_number": "605-886-8482",
            "fax_number": "605-884-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LENSSEN",
        "first_name": "STACIE",
        "middle_name": "A.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-27",
        "last_updated": "2022-05-17",
        "certification_date": "2022-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "5224",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5611460",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, SD

Sources for this page

Verify at the official NPI Registry.