NPIMap

Organization Active NPI

Mind Body Connections LLC

  • Psychiatric/Mental Health Clinical Nurse Specialist
  • Black Hawk, SD
National Provider Identifier
1295519213
Registry record updated Sep 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Clinical Nurse SpecialistTaxonomy code 364SP0808X
Legal business name
MIND BODY CONNECTIONS LLC
Practice address
8000 Black Hawk Rd Ste 4
Black Hawk, SD 57718-3315
Phone
(605) 431-3388
NPI assigned
Aug 21, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2023

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

Authorized official

Name
Jessica Koupal, DNP-FNP, QMHP, PMHNPNPI 1306488333
Title
Business Owner
Phone
(605) 431-3388

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X
Psychiatric/Mental Health Clinical Nurse SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 364SP0808X Primary

Addresses

Primary practice location

8000 Black Hawk Rd Ste 4
Black Hawk, SD 57718-3315

Mailing address

8000 Black Hawk Rd Ste 4
Black Hawk, SD 57718-3315
Phone (605) 431-3388

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241104003388 SD Part B Supplier - Clinic/Group Practice 0941733505 Receives reassigned benefits from 3 practitioners
Practice locations: Black Hawk, SD

National Provider Directory

National Provider Directory

Locations

8000 Black Hawk Rd
Ste 4
Black Hawk, SD 57718
Phone (605) 431-3388

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1692576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694044800000",
    "number": "1295519213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8000 BLACK HAWK RD STE 4",
            "city": "BLACK HAWK",
            "state": "SD",
            "postal_code": "577183315",
            "telephone_number": "605-431-3388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8000 BLACK HAWK RD STE 4",
            "city": "BLACK HAWK",
            "state": "SD",
            "postal_code": "577183315",
            "telephone_number": "605-431-3388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND BODY CONNECTIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-21",
        "last_updated": "2023-09-07",
        "certification_date": "2023-09-07",
        "status": "A",
        "authorized_official_last_name": "KOUPAL",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "BUSINESS OWNER",
        "authorized_official_telephone_number": "605-431-3388",
        "authorized_official_credential": "DNP-FNP, QMHP, PMHNP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "364SP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Black Hawk, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.