NPIMap

Individual provider Active NPI

Shane Thomas Gonnelly, PA-C

  • Physician Assistant
  • Spearfish, SD
National Provider Identifier
1275413189
Registry record updated Sep 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1635 Issued in SD
Practice address
2479 E Colorado Blvd
Spearfish, SD 57783-3204
Phone
(605) 644-4460
NPI assigned
Sep 3, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1635 SD Primary

Addresses

Primary practice location

2479 E Colorado Blvd
Spearfish, SD 57783-3204

Mailing address

1003 21St St NE
Watertown, SD 57201-6700

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
I20251204001354 SD Practitioner - Physician Assistant 3971096215 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Monument Health Network IncGroup PAC ID 5991616427, 163 clinicians

Practice addresses (Care Compare)

2479 E Colorado Blvd
Spearfish, SD 57783-3204
Phone (605) 644-4460

Hospital & facility affiliations

  • Monument Health Spearfish Hospital Hospital, Spearfish, SD, CCN 430048

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1635SDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Monument Health Network, Inc. CurrentSince Oct 3, 2025 Accepting new patients
Monument Health Network, Inc. Current Accepting new patients
Monument Health Network, Inc. CurrentSince Oct 3, 2025 Accepting new patients
Queen City Regional Medical Clinic Physician Assistant Past Accepting new patients

Locations

1440 N Main St
Spearfish, SD 57783
Phone (605) 644-4000

2479 E Colorado Blvd
Spearfish, SD 57783
Phone (605) 644-4460

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 7

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": "1756857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756857600000",
    "number": "1275413189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 21ST ST NE",
            "city": "WATERTOWN",
            "state": "SD",
            "postal_code": "572016700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2479 E COLORADO BLVD",
            "city": "SPEARFISH",
            "state": "SD",
            "postal_code": "577833204",
            "telephone_number": "605-644-4460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONNELLY",
        "first_name": "SHANE",
        "middle_name": "THOMAS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-09-03",
        "last_updated": "2025-09-03",
        "certification_date": "2025-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SD",
            "license": "1635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spearfish, SD

Sources for this page

Verify at the official NPI Registry.