NPIMap

Individual provider Active NPI

Jacob Kusmak

  • Dermatology Physician
  • Sioux Falls, SD
National Provider Identifier
1285833459
Registry record updated Apr 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
PENDING Issued in SD
Practice address
1310 W 22ND St
Sioux Falls, SD 57105-1501
Phone
(605) 328-8600
NPI assigned
Jul 17, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 5144 SD
Dermatology Physician 207N00000X PENDING SD Primary

Addresses

Primary practice location

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

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jkusmak7630@direct.sanfordhealth.org

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
I20120525000562 SD Practitioner - Dermatology 4789847971 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Sanford School of Medicine of University of South Dakota, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford Medical Center 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

1310 W 22ND St
Sioux Falls, SD 57105-1501
Phone (605) 328-8600

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

Hospital & facility affiliations

  • Sanford Usd Medical Center Hospital, Sioux Falls, SD, CCN 430027
  • Avera McKennan Hospital & University Health Center Hospital, Sioux Falls, SD, CCN 430016
  • Sanford Luverne Medical Center Hospital, Luverne, MN, CCN 241371

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

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision79
Removal of skin lesions1885
Removal of nail tissue1-10
Removal or shaving of skin growth298
Skin biopsy24

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PENDINGSDMDClinical Psychologist
5144SDMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Clinic CurrentSince Apr 2, 2012 Accepting new patients
Sanford Medical Center Dermatology CurrentSince Apr 2, 2012 Accepting new patients
Sanford Clinic CurrentSince Apr 2, 2012 Accepting new patients
Sanford Clinic Current Accepting new patients
Sanford Medical Center CurrentSince Apr 2, 2012 Accepting new patients
Sanford Clinic Past Accepting new patients

Locations

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

1310 W 22nd St
Uppr
Sioux Falls, SD 57105

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

1310 W 22nd St
Sioux Falls, SD 57105
Phone (605) 328-8200

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

Organizations & group practices 18

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 18

Hospital & facility affiliations 28

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 28

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651190400000",
    "number": "1285833459",
    "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"
        },
        {
            "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": "605-328-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUSMAK",
        "first_name": "JACOB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-17",
        "last_updated": "2022-04-29",
        "certification_date": "2022-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "SD",
            "license": "5144",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "SD",
            "license": "PENDING",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jkusmak7630@direct.sanfordhealth.org",
            "affiliation": "N",
            "address_1": "1310 W 22nd St",
            "city": "Sioux Falls",
            "state": "SD",
            "country_code": "US",
            "postal_code": "571051501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.