NPIMap

Individual provider Active NPI

Mark Gregory Desautel, MD

  • Otolaryngology Physician
  • Sioux Falls, SD
National Provider Identifier
1255338174
Registry record updated Jun 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
4246 Issued in SD
Practice address
1310 W 22ND St
Sioux Falls, SD 57105-1501
Phone
(605) 328-8200
Fax
(605) 328-8201
NPI assigned
Jul 7, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2014

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 4246 SD Primary
Pediatric Otolaryngology Physician 207YP0228X 4246 SD
Facial Plastic Surgery Physician 207YS0123X 4246 SD
Otolaryngic Allergy Physician 207YX0602X 4246 SD
Otology & Neurotology Physician 207YX0901X 4246 SD
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X 4246 SD

Addresses

Primary practice location

1310 W 22ND St
Sioux Falls, SD 57105-1501

Mailing address

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

Other identifiers 4

IdentifierTypeStateIssuer
4996176OtherSDBLUE SHIELD
8015163000MedicaidMN
6520242MedicaidSD
1986174MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA, MN, SD3 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 3

Enrollment IDStateProvider typePAC IDDetails
I20040608000652 IA Practitioner - Otolaryngology 4789596909 Reassigns benefits to 1 organization
I20050818000924 MN Practitioner - Otolaryngology 4789596909
I20060712000070 SD Practitioner - Otolaryngology 4789596909 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
University of Iowa, RJ & L Carver College of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera McKennanGroup PAC ID 0345157103, 957 clinicians

Practice addresses (Care Compare)

1000 E 23Rd St
Sioux Falls, SD 57105-2114

1325 S Cliff Ave
Sioux Falls, SD 57105-1007

1417 S Cliff Ave
Suite 300
Sioux Falls, SD 57105-1062
Phone (605) 504-3000

901 E Virgil Ave
Milbank, SD 57252-2124
Phone (605) 432-4538

Hospital & facility affiliations

  • Avera McKennan Hospital & University Health Center Hospital, Sioux Falls, SD, CCN 430016
  • Sanford Usd Medical Center Hospital, Sioux Falls, SD, CCN 430027

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4246SDMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Spencer Municipal Hospital Current Accepting new patients
Spencer Municipal Hospital CurrentSince Jun 1, 2020 Accepting new patients
Avera McKennan Current Accepting new patients
Spencer Municipal Hospital Current Accepting new patients
Avera McKennan CurrentSince Nov 8, 2021 Accepting new patients
Avera McKennan CurrentSince Nov 8, 2021 Accepting new patients
Spencer Municipal Hospital Otolaryngology CurrentSince Jun 1, 2020 Accepting new patients
Midwest Ear, Nose & Throat Associates P C Otolaryngology PastSince Apr 30, 2003 Accepting new patients

Locations

920 Grand Ave
Spencer, IA 51301
Phone (712) 262-4121

1200 1st Ave E
Spencer, IA 51301
Phone (712) 264-6164

2301 Highway 71
Spirit Lake, IA 51360
Phone (712) 336-3750

300 S Bruce St
Marshall, MN 56258
Phone (507) 532-9631

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

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

Interoperability endpoints

  • Direct secure messaging: gregory.desautel@avera.sdhealthlink.net

Organizations & group practices 8

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 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": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402444800000",
    "number": "1255338174",
    "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": "1310 W 22ND ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051501",
            "telephone_number": "605-328-8200",
            "fax_number": "605-328-8201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESAUTEL",
        "first_name": "MARK",
        "middle_name": "GREGORY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2014-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "SD",
            "license": "4246",
            "primary": true
        },
        {
            "code": "207YP0228X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Pediatric Otolaryngology",
            "state": "SD",
            "license": "4246",
            "primary": false
        },
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "SD",
            "license": "4246",
            "primary": false
        },
        {
            "code": "207YX0602X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngic Allergy",
            "state": "SD",
            "license": "4246",
            "primary": false
        },
        {
            "code": "207YX0901X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otology & Neurotology",
            "state": "SD",
            "license": "4246",
            "primary": false
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "SD",
            "license": "4246",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "4996176",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8015163000",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6520242",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1986174",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.