Active NPI
Joanne Tikka Detwiler, P.A.-C
- Physician Assistant
- Rapid City, SD
National Provider Identifier
1265543151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0185
- Practice address
- 2820 Mount Rushmore Rd
Rapid City, SD 57701-5462 - Phone
- (605) 342-3280
- Fax
- (605) 721-8439
- NPI assigned
- Aug 31, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0185 | SD | Primary |
Addresses
Primary practice location
2820 Mount Rushmore Rd
Rapid City, SD 57701-5462
Mailing address
3802 Cosport CT
Rapid City, SD 57702-6936
Phone (605) 791-5385
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0185 | SD | MD | General Acute Care Hospital |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rushmore Clinic, P.C. | Physician Assistant | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1244505600000",
"number": "1265543151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3802 COSPORT CT",
"city": "RAPID CITY",
"state": "SD",
"postal_code": "577026936",
"telephone_number": "605-791-5385"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2820 MOUNT RUSHMORE RD",
"city": "RAPID CITY",
"state": "SD",
"postal_code": "577015462",
"telephone_number": "605-342-3280",
"fax_number": "605-721-8439"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DETWILER",
"first_name": "JOANNE",
"middle_name": "TIKKA",
"name_prefix": "Ms.",
"credential": "P.A.-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-31",
"last_updated": "2009-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "SD",
"license": "0185",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rapid City, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.