NPIMap

Mary Beth Ellis, CRNA

Individual provider Active NPI Certified Registered Nurse Anesthetist · Sioux Falls, SD

NPI 1306136098 · NPPES record last updated Sep 1, 2011

Key facts

NPI
1306136098
Entity type
Individual (NPI type 1)
Primary specialty
Certified Registered Nurse Anesthetist 367500000X
License
CR000759 (SD)
Practice address
1325 S Cliff Ave
Sioux Falls, SD 57105-1007
Phone
(605) 322-2754
NPI assigned
Apr 14, 2011
Sex
Female
Sole proprietor
No

Organizations & group practices 22

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.

Hospital & facility affiliations 3

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

Medicare Care Compare profile

Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2011
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

Hospital & facility affiliations

  • Sanford Usd Medical Center Hospital · Sioux Falls, SD · CCN 430027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in SD

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20110513000239 SD Practitioner - Certified Registered Nurse Anesthetist (Crna) 4284810979 Reassigns benefits to 4 organizations

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
CR000759SDMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center Current
since Nov 13, 2011		 Accepting new patients
Avera McKennan Current Accepting new patients
Sanford Health Network Current
since Oct 14, 2012		 Accepting new patients
Avera McKennan Nurse Anesthetist, Certified Registered Current
since Apr 18, 2011		 Accepting new patients
Sanford Health Network Current
since Oct 14, 2012		 Accepting new patients
Avera McKennan Current
since Apr 18, 2011		 Accepting new patients
Siouxland Anesthesiology, LTD Nurse Anesthetist, Certified Registered Current
since Apr 11, 2023		 Accepting new patients
Sanford Health Network Current Accepting new patients

Locations

701 3rd Ave S
Clear Lake, SD 57226
Phone (605) 874-2141

909 N Iowa Ave
Dell Rapids, SD 57022
Phone (605) 428-5431

101 Tower Rd
Ste 201
North Sioux City, SD 57049
Phone (605) 232-3332

600 N Sioux Point Rd
North Sioux City, SD 57049
Phone (605) 217-4320

1325 S Cliff Ave
Sioux Falls, SD 57105
Phone (605) 322-5000

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

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

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X CR000759 SD Yes

Addresses

Primary practice location

1325 S Cliff Ave
Sioux Falls, SD 57105-1007

Mailing address

PO Box 5045
Attn: P.F.S. Prov Enroll
Sioux Falls, SD 57117-5045
Phone (605) 322-6428

Other identifiers

IdentifierTypeStateIssuer
1306136098OtherDAKOTACARE
1306136098OtherBCBS MN

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 1, 2011.

{
    "created_epoch": "1302739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314835200000",
    "number": "1306136098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5045",
            "address_2": "ATTN: P.F.S. PROV ENROLL",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175045",
            "telephone_number": "605-322-6428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 S CLIFF AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051007",
            "telephone_number": "605-322-2754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "MARY",
        "middle_name": "BETH",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-14",
        "last_updated": "2011-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "SD",
            "license": "CR000759",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAKOTACARE",
            "identifier": "1306136098",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MN",
            "identifier": "1306136098",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux Falls, SD

All providers in Sioux Falls, SD · Certified Registered Nurse Anesthetist in South Dakota

Sources for this page

Verify at the official NPI Registry.