Individual provider Active NPI

Renee E Ullom, PA-C

  • Physician Assistant
  • Sioux Falls, SD
National Provider Identifier
1346213402
Registry record updated Oct 24, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0554 Issued in SD
Practice address
1305 W 18TH St
Sioux Falls, SD 57105-0401
Phone
(605) 333-1000
NPI assigned
Feb 9, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0554 SD Primary

Addresses

Primary practice location

1305 W 18TH St
Sioux Falls, SD 57105-0401

Mailing address

PO Box 5053
Sioux Falls, SD 57117-5053
Phone (605) 328-6548

Other identifiers 1

IdentifierTypeStateIssuer
6825490MedicaidSD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040322000244 SD Practitioner - Physician Assistant 7618868647 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
84.78 of 100Reported as group
Quality
78.77
Promoting interoperability
100
Improvement activities
40
Cost
70.49

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center CurrentSince Dec 1, 2003 Accepting new patients
Sanford Medical Center Physician Assistant CurrentSince Dec 1, 2003 Accepting new patients

Locations

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

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

401 9th Ave NW
Watertown, SD 57201
Phone (605) 886-9317

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.

NPI Registry JSON

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

{
    "created_epoch": "1139443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193184000000",
    "number": "1346213402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5053",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175053",
            "telephone_number": "605-328-6548",
            "fax_number": "605-328-6512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 W 18TH ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571050401",
            "telephone_number": "605-333-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ULLOM",
        "first_name": "RENEE",
        "middle_name": "E",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-09",
        "last_updated": "2007-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SD",
            "license": "0554",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6825490",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.