NPIMap

Individual provider Active NPI

Jeffrey Patrick Stephens

  • Family Medicine Physician
  • Custer, SD
National Provider Identifier
1336601731
Registry record updated Jul 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
17584 Issued in SD
Practice address
1220 Montgomery St
Custer, SD 57730-1705
Phone
(605) 673-9400
NPI assigned
Apr 3, 2019
Last updated
Jul 18, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Student in an Organized Health Care Education/Training Program 390200000X TL.0009417 CO
Family Medicine Physician 207Q00000X 17584 SD Primary

Addresses

Primary practice location

1220 Montgomery St
Custer, SD 57730-1705

Mailing address

11903 Emerald Rd
Custer, SD 57730-8172
Phone (313) 580-3861

Other practice location 1

1000 W Carson St
Torrance, CA 90502-2004
Phone (310) 222-2716

Other practice location 2

1600 23rd Ave
Greeley, CO 80634-6070
Phone (970) 810-2815

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
I20251015004132 SD Practitioner - Family Practice 7416335369 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Wayne State University School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Monument Health Network IncGroup PAC ID 5991616427, shared by 12 NPIs, 163 clinicians

Practice addresses (Care Compare)

1220 Montgomery St
Custer, SD 57730-1705
Phone (605) 673-4150

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Monument Health Network, Inc. Family Medicine CurrentSince Aug 14, 2025 Accepting new patients
Monument Health Network, Inc. Current Accepting new patients
Monument Health Network, Inc CurrentSince Aug 14, 2025 Accepting new patients
Queen City Regional Medical Clinic Past Accepting new patients

Locations

1220 Montgomery St
Custer, SD 57730
Phone (605) 673-4150

1440 N Main St
Spearfish, SD 57783
Phone (605) 644-4000

Organizations & group practices 4

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 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1554249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752796800000",
    "number": "1336601731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11903 EMERALD RD",
            "city": "CUSTER",
            "state": "SD",
            "postal_code": "577308172",
            "telephone_number": "313-580-3861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 MONTGOMERY ST",
            "city": "CUSTER",
            "state": "SD",
            "postal_code": "577301705",
            "telephone_number": "605-673-9400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 W Carson St",
            "address_purpose": "LOCATION",
            "city": "Torrance",
            "state": "CA",
            "postal_code": "905022004",
            "country_code": "US",
            "telephone_number": "310-222-2716",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1600 23rd Ave",
            "address_purpose": "LOCATION",
            "city": "Greeley",
            "state": "CO",
            "postal_code": "806346070",
            "country_code": "US",
            "telephone_number": "970-810-2815",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STEPHENS",
        "first_name": "JEFFREY",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-03",
        "last_updated": "2025-07-18",
        "certification_date": "2025-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CO",
            "license": "TL.0009417",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "17584",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Custer, SD

Sources for this page

Verify at the official NPI Registry.