NPIMap

Individual provider Active NPI

Jaclyn Michelle Spencer, CRNA

  • Certified Registered Nurse Anesthetist
  • Rapid City, SD
National Provider Identifier
1336716869
Registry record updated Jun 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
CR001070 Issued in SD
Practice address
353 Fairmont Blvd
Rapid City, SD 57701-7375
Phone
(605) 755-1000
NPI assigned
Jun 4, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 4, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X CR001070 SD Primary

Addresses

Primary practice location

353 Fairmont Blvd
Rapid City, SD 57701-7375

Mailing address

353 Fairmont Blvd
Rapid City, SD 57701-7375
Phone (605) 755-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD, MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210701002916 SD Practitioner - Certified Registered Nurse Anesthetist (Crna) 4981005675 Reassigns benefits to 4 organizations
I20240221002710 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 4981005675 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford Health of Northern MinnesotaGroup PAC ID 5597725168, 349 clinicians
Black Hills Surgical Hospital LLCGroup PAC ID 5496742835, 173 clinicians
Monument Health Rapid City Hospital IncGroup PAC ID 6002729506, 560 clinicians

Practice addresses (Care Compare)

1611 Anne St NW
Bemidji, MN 56601-5114
Phone (218) 333-5000

216 Anamaria Dr
Rapid City, SD 57701-7366
Phone (605) 721-4700

353 Fairmont Blvd
Rapid City, SD 57701-7375
Phone (605) 755-1000

Hospital & facility affiliations

  • Black Hills Surgical Hospital LLC Hospital, Rapid City, SD, CCN 430091
  • Monument Health Rapid City Hospital Hospital, Rapid City, SD, CCN 430077
  • Sanford Bemidji Medical Center Hospital, Bemidji, MN, CCN 240100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
2923MNMDRegistered Dietitian
CR001070SDMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Peloton Anesthesia, PLLC Single Specialty CurrentSince Jan 1, 2023 Accepting new patients
Monument Health Rapid City Hospital, Inc Single Specialty Current Accepting new patients
Sanford Health of Northern Minnesota Single Specialty CurrentSince Feb 5, 2024 Accepting new patients
Black Hills Surgical Hospital, LLC Single Specialty CurrentSince Aug 24, 2023 Accepting new patients
Monument Health Rapid City Hospital Inc CurrentSince Jun 9, 2021 Accepting new patients
Monument Health Rapid City Hospital, Inc Single Specialty CurrentSince Jun 9, 2021 Accepting new patients
Sanford Health of Northern Minnesota Single Specialty CurrentSince Feb 5, 2024 Accepting new patients
Sanford Health of Northern Minnesota Single Specialty Current Accepting new patients
Black Hills Surgical Hospital, LLC Single Specialty CurrentSince Aug 24, 2023 Accepting new patients

Locations

1611 Anne St NW
Bemidji, MN 56601
Phone (218) 333-2020

1400 Highway 71
Intl Falls, MN 56649
Phone (218) 283-4481

400 10th St E
Waconia, MN 55387

353 Fairmont Blvd
Rapid City, SD 57701
Phone (605) 719-1000

1868 Lombardy Dr
Rapid City, SD 57703
Phone (605) 721-4900

216 Anamaria Dr
Rapid City, SD 57701
Phone (605) 388-9440

2820 Mount Rushmore Rd
Rapid City, SD 57701
Phone (605) 721-8121

Organizations & group practices 10

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 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": "1622764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622764800000",
    "number": "1336716869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "353 FAIRMONT BLVD",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577017375",
            "telephone_number": "605-755-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "353 FAIRMONT BLVD",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577017375",
            "telephone_number": "605-755-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPENCER",
        "first_name": "JACLYN",
        "middle_name": "MICHELLE",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-04",
        "last_updated": "2021-06-04",
        "certification_date": "2021-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "SD",
            "license": "CR001070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rapid City, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.