NPIMap

Individual provider Active NPI

Mark E Bubak, MD

  • Allergy & Immunology (Internal Medicine) Physician
  • Sioux Falls, SD
National Provider Identifier
1336196724
Registry record updated Feb 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology (Internal Medicine) PhysicianTaxonomy code 207RA0201X
License
3512 Issued in SD
Practice address
2200 W 49TH St Ste 104
Sioux Falls, SD 57105-6550
Phone
(605) 336-6385
Fax
(605) 336-6513
NPI assigned
May 30, 2006
Last updated
Feb 21, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology (Internal Medicine) Physician 207RA0201X 3512 SD Primary

Addresses

Primary practice location

2200 W 49TH St Ste 104
Sioux Falls, SD 57105-6550

Mailing address

PO Box 5126
Sioux Falls, SD 57117-5126
Phone (605) 335-1952

Other identifiers 5

IdentifierTypeStateIssuer
1981852MedicaidIA
792302300MedicaidMN
5900042MedicaidSD
73Q32BUOtherMNBCBS
0007519OtherSDBCBS

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
I20041007000241 SD Practitioner - Allergy/Immunology 2961461736 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Allergy/Immunology
Education
Sanford School of Medicine of University of South Dakota, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dakota Allergy and Asthma LTDGroup PAC ID 7810979002, 4 clinicians

Practice addresses (Care Compare)

2200 W 49TH St
Suite 104
Sioux Falls, SD 57105-6550
Phone (605) 336-6385

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3512SDMDAllergy & Immunology (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dakota Allergy & Asthma LTD Allergy & Immunology CurrentSince Jan 2, 2001 Accepting new patients

Locations

2200 W 49th St
Ste 104
Sioux Falls, SD 57105
Phone (605) 336-6385

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361404800000",
    "number": "1336196724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5126",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175126",
            "telephone_number": "605-335-1952",
            "fax_number": "605-373-9971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 W 49TH ST STE 104",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571056550",
            "telephone_number": "605-336-6385",
            "fax_number": "605-336-6513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUBAK",
        "first_name": "MARK",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-30",
        "last_updated": "2013-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RA0201X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Allergy & Immunology",
            "state": "SD",
            "license": "3512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1981852",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "792302300",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5900042",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "73Q32BU",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0007519",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.