Rivers Edge Aesthetic Surgery, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

RIVERS EDGE AESTHETIC SURGERY, LLC

Practice address

4201 South Minnesota Avenue
Ste. 111
Sioux Falls, SD 57105-6742

Phone

(605) 335-3349

Fax

(605) 336-8436

NPI assigned

Nov 17, 2010

Last updated

Jan 30, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Marvin E Smoot

Title

Director

Phone

(605) 335-3349

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

Listed as

Rivers Edge Aesthetic Surgery LLCCCN 43C0001029

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lance D Breit, CRNA

  • Certified Registered Nurse Anesthetist
  • Sioux City, IA
  • NPI 1013954148

  SD

  Medicare reassignment NPD
• James Anthony Breit, MD

  • Plastic and Reconstructive Surgery Physician
  • Sioux Falls, SD
  • NPI 1972582021
  NPD (past)
• Brady Jay Coburn, MD

  • Plastic Surgery Physician
  • Maywood, IL
  • NPI 1811491202
  NPD (past)

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

{
    "created_epoch": "1289952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580342400000",
    "number": "1285936641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 SOUTH MINNESOTA AVENUE",
            "address_2": "STE. 111",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571056742",
            "telephone_number": "605-335-3349",
            "fax_number": "605-336-8436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 SOUTH MINNESOTA AVENUE",
            "address_2": "STE. 111",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571056742",
            "telephone_number": "605-335-3349",
            "fax_number": "605-336-8436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERS EDGE AESTHETIC SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-17",
        "last_updated": "2020-01-30",
        "certification_date": "2020-01-30",
        "status": "A",
        "authorized_official_last_name": "SMOOT",
        "authorized_official_first_name": "MARVIN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "605-335-3349"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Marie Ritzman, MS, NCC, LPC-MH, RPT
• River District Counseling LLC
• River Ridge Oral & Maxillofacial Surgical Center
• River Ridge Spine & Rehabilitation Center PC
• River Ridge Spine and Rehabilitation Center
• Samantha A Rivet, OD
• RLF Family Eyecare Prof LLC
• RLF Optometry LLC (Complete Eyecare)
• Abrea Ann Roark, M.D.
• Bethany Lynn Robasse, PHARM.D.

• Ambulatory Surgical Clinic/Center in Sioux Falls, SD
• Providers in Sioux Falls, SD by specialty
• Ambulatory Surgical Clinic/Center in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.