NPIMap

Individual provider Active NPI

Matthew Lee Hustrulid, MD

  • Diagnostic Radiology Physician
  • Rapid City, SD
National Provider Identifier
1316467053
Registry record updated May 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
14255 Issued in SD
Practice address
2929 5TH St
Rapid City, SD 57701-7363
Phone
(605) 342-2852
Fax
(605) 342-3930
NPI assigned
Jun 23, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X R-11049 IA
Diagnostic Radiology Physician 2085R0202X 14255 SD Primary

Addresses

Primary practice location

2929 5TH St
Rapid City, SD 57701-7363

Mailing address

200 Hawkins Dr.
Department of Radiology
Iowa City, IA 52242-1009
Phone (319) 356-3444

Other practice location 1

200 Hawkins Dr Dept Of
Iowa City, IA 52242-1009
Phone (319) 356-3444

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
I20230717003573 SD Practitioner - Diagnostic Radiology 1052771458 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Imaging Center LLCGroup PAC ID 0345347803, 18 clinicians
Radiology Associates Prof LLCGroup PAC ID 0941192314, 18 clinicians

Practice addresses (Care Compare)

2929 5TH St
Suite 100
Rapid City, SD 57701-7355
Phone (605) 721-1662

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75.2 of 100Reported as group
Quality
70.83
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
86.24 of 100Reported as group
Quality
88.01
Improvement activities
40
Cost
76.11

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R-11049IAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Radiology Associates Prof, LLC Diagnostic Radiology CurrentSince Jul 1, 2023 Accepting new patients
The Imaging Center, LLC Diagnostic Radiology CurrentSince Jul 1, 2023 Accepting new patients

Locations

2929 5th St
Ste 100
Rapid City, SD 57701
Phone (605) 342-2852

Organizations & group practices 2

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 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1498176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685404800000",
    "number": "1316467053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HAWKINS DR.",
            "address_2": "DEPARTMENT OF RADIOLOGY",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522421009",
            "telephone_number": "319-356-3444",
            "fax_number": "319-384-8114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2929 5TH ST",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577017363",
            "telephone_number": "605-342-2852",
            "fax_number": "605-342-3930"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Hawkins Dr Dept Of",
            "address_purpose": "LOCATION",
            "city": "Iowa City",
            "state": "IA",
            "postal_code": "522421009",
            "country_code": "US",
            "telephone_number": "319-356-3444",
            "fax_number": "319-384-8114",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HUSTRULID",
        "first_name": "MATTHEW",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-23",
        "last_updated": "2023-05-30",
        "certification_date": "2023-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IA",
            "license": "R-11049",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "SD",
            "license": "14255",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rapid City, SD

Sources for this page

Verify at the official NPI Registry.