NPIMap

Individual provider Active NPI

Jacek Bednarz Jr., DO

  • Family Medicine Physician
  • Aberdeen, SD
National Provider Identifier
1255911145
Registry record updated Jul 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
15558 Issued in SD
Practice address
105 S State St Ste 113
Aberdeen, SD 57401-4502
Phone
(605) 225-0378
NPI assigned
Apr 13, 2021
Last updated
Jul 19, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2024

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 15558 SD Primary

Addresses

Primary practice location

105 S State St Ste 113
Aberdeen, SD 57401-4502

Mailing address

105 S State St Ste 113
Aberdeen, SD 57401-4502
Phone (605) 225-0378

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
I20241003003855 SD Practitioner - Family Practice 4385045475 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Lincoln Mem Univ, Debusk Col of Osteopathic Med, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera St LukesGroup PAC ID 6406764927, 164 clinicians

Practice addresses (Care Compare)

105 S State St
Aberdeen, SD 57401-4502

8 E US Hwy 12
Groton, SD 57445-2176
Phone (605) 397-4242

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions20
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
15558SDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Avera St. Luke's Current Accepting new patients
Avera St. Lukes CurrentSince Jul 31, 2024 Accepting new patients
Avera St. Luke's CurrentSince Jul 31, 2024 Accepting new patients

Locations

105 S State St
Ste 113
Aberdeen, SD 57401
Phone (605) 225-0378

Interoperability endpoints

  • Direct secure messaging: jacek.bednarz@avera.sdhealthlink.net

Organizations & group practices 3

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 9

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": "1618272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721347200000",
    "number": "1255911145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 S STATE ST STE 113",
            "city": "ABERDEEN",
            "state": "SD",
            "postal_code": "574014502",
            "telephone_number": "605-225-0378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 S STATE ST STE 113",
            "city": "ABERDEEN",
            "state": "SD",
            "postal_code": "574014502",
            "telephone_number": "605-225-0378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEDNARZ",
        "first_name": "JACEK",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-13",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "15558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aberdeen, SD

Sources for this page

Verify at the official NPI Registry.