NPIMap

Individual provider Active NPI

Mariah Peterson, CNP

  • Family Nurse Practitioner
  • Flandreau, SD
National Provider Identifier
1245019694
Registry record updated Nov 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
CP002971 Issued in SD
Practice address
212 N Prairie St
Flandreau, SD 57028-1243
Phone
(605) 997-2433
NPI assigned
Sep 25, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X R051425 SD
Family Nurse Practitioner 363LF0000X CP002971 SD Primary

Addresses

Primary practice location

212 N Prairie St
Flandreau, SD 57028-1243

Mailing address

212 N Prarie St
Flandreau, SD 57028
Phone (605) 579-0283

Other names 1

  • Mariah Noid Former name

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
I20231211003108 SD Practitioner - Nurse Practitioner 2961851381 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera McKennanGroup PAC ID 0345157103, shared by 52 NPIs, 957 clinicians

Practice addresses (Care Compare)

203 N Elk St
Elkton, SD 57026-2103
Phone (605) 542-7701

212 N Prairie St
Flandreau, SD 57028-1243

214 N Prairie St
Flandreau, SD 57028-1243
Phone (605) 997-2433

Hospital & facility affiliations

  • Avera Flandreau Hospital - Cah Hospital, Flandreau, SD, CCN 431310
  • Avera McKennan Hospital & University Health Center Hospital, Sioux Falls, SD, CCN 430016

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R051425SDMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince Oct 30, 2023 Accepting new patients
Avera McKennan CurrentSince Nov 1, 2025 Accepting new patients
Avera McKennan CurrentSince Oct 30, 2023 Accepting new patients
Avera McKennan Current Accepting new patients
Avera McKennan Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mariah.noid@avera.sdhealthlink.net

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 and National Provider Directory roles.

Hospital & facility affiliations 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1695600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730937600000",
    "number": "1245019694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 N PRARIE ST",
            "city": "FLANDREAU",
            "state": "SD",
            "postal_code": "57028",
            "telephone_number": "605-579-0283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 N PRAIRIE ST",
            "city": "FLANDREAU",
            "state": "SD",
            "postal_code": "570281243",
            "telephone_number": "605-997-2433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MARIAH",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-25",
        "last_updated": "2024-11-07",
        "certification_date": "2023-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "SD",
            "license": "R051425",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SD",
            "license": "CP002971",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIAH",
            "last_name": "NOID",
            "credential": "CNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Flandreau, SD

Sources for this page

Verify at the official NPI Registry.