NPIMap

Individual provider Active NPI

Jacqueline Kelley

  • Nurse Practitioner
  • Sioux Falls, SD
National Provider Identifier
1245644780
Registry record updated Jul 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
R035299 Issued in SD
Practice address
1309 W 17TH St Ste 101
Sioux Falls, SD 57104-8805
Phone
(605) 328-8000
Fax
(605) 328-8001
NPI assigned
Jun 12, 2014
Last updated
Jul 1, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2019

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 R035299 SD Primary

Addresses

Primary practice location

1309 W 17TH St Ste 101
Sioux Falls, SD 57104-8805

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074
Phone (605) 328-6585

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD, MN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160301000920 SD Practitioner - Nurse Practitioner 3971808874 Reassigns benefits to 2 organizations
I20170511001170 MN Practitioner - Nurse Practitioner 3971808874 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sanford Medical CenterGroup PAC ID 8325950215, 847 clinicians

Practice addresses (Care Compare)

1301 W 18TH St
Sioux Falls, SD 57105-0401
Phone (605) 312-2200

1305 W 18TH St
Sioux Falls, SD 57105-0401
Phone (605) 312-7300

1309 W 17TH St
Sioux Falls, SD 57104-8805

4405 E 26TH St
Sioux Falls, SD 57103-4187
Phone (605) 332-2883

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.78 of 100Reported as group
Quality
78.77
Promoting interoperability
100
Improvement activities
40
Cost
70.49

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4712MNMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center Nurse Practitioner CurrentSince Jul 1, 2022 Accepting new patients
Sanford Clinic Nurse Practitioner Current Accepting new patients
Sanford Clinic CurrentSince Jan 20, 2016 Accepting new patients
Sanford Clinic Nurse Practitioner Current Accepting new patients
Sanford Health Network CurrentSince Jul 10, 2021 Accepting new patients
Sanford Clinic CurrentSince Apr 8, 2017 Accepting new patients
Sanford Health Network Nurse Practitioner CurrentSince Jul 10, 2021 Accepting new patients
Sanford Health Network Nurse Practitioner Current Accepting new patients
Sanford Medical Center CurrentSince Jul 1, 2022 Accepting new patients
Sanford Clinic Nurse Practitioner Past Accepting new patients
Sanford Clinic Past Accepting new patients
Sanford Clinic Past Accepting new patients

Locations

2150 Hospital Dr
Windom, MN 56101
Phone (507) 831-0618

1018 6th Ave
Worthington, MN 56187
Phone (507) 343-6100

525 N Foster St
Mitchell, SD 57301
Phone (605) 995-2000

1305 W 18th St
Sioux Falls, SD 57105
Phone (605) 312-7300

1309 W 17th St
Ste 101
Sioux Falls, SD 57104
Phone (605) 328-8000

4405 E 26th St
Sioux Falls, SD 57103
Phone (605) 328-9000

Organizations & group practices 12

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 11

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": "1402531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561939200000",
    "number": "1245644780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074",
            "telephone_number": "605-328-6585",
            "fax_number": "605-328-6512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1309 W 17TH ST STE 101",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571048805",
            "telephone_number": "605-328-8000",
            "fax_number": "605-328-8001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "JACQUELINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-12",
        "last_updated": "2019-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SD",
            "license": "R035299",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.