Mikaela A Penaredondo, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

1417 Issued in SD

Practice address

6100 S Louise Ave
Sioux Falls, SD 57108-6029

Phone

(605) 504-1000

NPI assigned

Feb 4, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Other names 1

• Mikaela A Dierks Former name

Medicare fee-for-service enrollment

Enrolled in SD

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Avera McKennan

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Sioux Falls, SD
  • NPI 1699009944
  Medicare reassignment
• Avera McKennan

  • Emergency Medicine Physician
  • Sioux Falls, SD
  • NPI 1013350891
  NPD
• Avera McKennan

  • Diagnostic Radiology Physician
  • Sioux Falls, SD
  • NPI 1053680678
  NPD

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

{
    "created_epoch": "1359936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704844800000",
    "number": "1346589876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6100 S LOUISE AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571086029",
            "telephone_number": "605-504-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6100 S LOUISE AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571086029",
            "telephone_number": "605-504-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "426 10th St",
            "address_purpose": "LOCATION",
            "city": "Worthington",
            "state": "MN",
            "postal_code": "561872341",
            "country_code": "US",
            "telephone_number": "507-372-3890",
            "fax_number": "507-372-3891",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 1st St SW",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "MN",
            "postal_code": "559051906",
            "country_code": "US",
            "telephone_number": "507-284-2511",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1216 2nd St SW",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "MN",
            "postal_code": "559021906",
            "country_code": "US",
            "telephone_number": "507-255-5123",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENAREDONDO",
        "first_name": "MIKAELA",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-04",
        "last_updated": "2024-01-10",
        "certification_date": "2024-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NE",
            "license": "1709",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MN",
            "license": "2069",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MN",
            "license": "11579",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SD",
            "license": "1417",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "11579",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIKAELA",
            "last_name": "DIERKS",
            "middle_name": "A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Hillary Ayn Peirce, PA-C
• Michael Wayne Pekas
• Christina Jean Pekoske
• Aaron Pemberton, M.D.
• Gabriel Penaredondo, PA-C
• Anita A Pendo, CNP
• Paul G Penn, OD
• Brian Sabado Pepito, M.D.
• Rebecca Jean Peppel, OTR/L
• Arthur James Pepper, CNP

• Medical Physician Assistant in Sioux Falls, SD
• Providers in Sioux Falls, SD by specialty
• Medical Physician Assistant in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.