NPIMap

Organization Active NPI

Black Hills Regional Eye Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Rapid City, SD
National Provider Identifier
1346220183
Registry record updated Dec 28, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
11143 Issued in SD
Legal business name
BLACK HILLS REGIONAL EYE SURGERY CENTER, LLC
Practice address
2800 3Rd St
Rapid City, SD 57701-7374
Phone
(605) 341-2000
Fax
(605) 719-3211
NPI assigned
Jan 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2007

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

Authorized official

Name
Mrs. Jodi J Anderson, CPA
Title
Chief Financial Officer
Phone
(605) 341-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 11143 SD Primary

Addresses

Primary practice location

2800 3Rd St
Rapid City, SD 57701-7374

Mailing address

2800 3Rd St
Rapid City, SD 57701-7374
Phone (605) 341-2000

Other identifiers 1

IdentifierTypeStateIssuer
5490052MedicaidSD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090625000089 SD Part B Supplier - Ambulatory Surgical Center 7113909201 Receives reassigned benefits from 5 practitioners
Practice locations: Rapid City, SD

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Black Hills Regional Eye Surgery Center LLCCCN 43C0001003
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Black Hills Reg Eye Sur2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198800000000",
    "number": "1346220183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 3RD ST",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577017374",
            "telephone_number": "605-341-2000",
            "fax_number": "605-719-3211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 3RD ST",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577017374",
            "telephone_number": "605-341-2000",
            "fax_number": "605-719-3211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK HILLS REGIONAL EYE SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-18",
        "last_updated": "2007-12-28",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "JODI",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "605-341-2000",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "SD",
            "license": "11143",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5490052",
            "state": "SD"
        }
    ],
    "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 Dec 28, 2007; 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.