NPIMap

Individual provider Active NPI

Kendra Nordahl, NP-C

  • Nurse Practitioner
  • Rapid City, SD
National Provider Identifier
1346915584
Registry record updated Jul 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
CP002105 Issued in SD
Practice address
4141 5TH St
Rapid City, SD 57701-6021
Phone
(605) 341-1414
Fax
(605) 341-7062
NPI assigned
Aug 10, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X CP002105 SD Primary

Addresses

Primary practice location

4141 5TH St
Rapid City, SD 57701-6021

Mailing address

PO Box 6850
Rapid City, SD 57709-6850
Phone (605) 341-1414

Other names 1

  • Kendra Crisman Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD, ND2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210923002427 SD Practitioner - Nurse Practitioner 8820495476 Reassigns benefits to 2 organizations
I20230831001012 ND Practitioner - Nurse Practitioner 8820495476 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Black Hills Surgical Hospital LLCGroup PAC ID 5496742835, 173 clinicians
Omaha Therapy IncGroup PAC ID 1557270915, 68 clinicians

Practice addresses (Care Compare)

216 Anamaria Dr
Rapid City, SD 57701-7366
Phone (605) 791-7777

4141 5TH St
Rapid City, SD 57701-6021
Phone (605) 341-1414

683 State Ave
Dickinson, ND 58601-4660
Phone (701) 483-9400

7220 Mount Rushmore Rd
Rapid City, SD 57702-8754
Phone (605) 737-9151

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
CP002105SDMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Black Hills Orthopedic & Spine Center, Inc. CurrentSince Apr 18, 2022 Accepting new patients

Locations

802 2nd St NW
Bowman, ND 58623
Phone (701) 523-3214

4141 5th St
Rapid City, SD 57701
Phone (605) 341-2424

7220 Mount Rushmore Rd
Rapid City, SD 57702
Phone (605) 737-9144

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.71180

Organizations & group practices 3

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 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1628553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721606400000",
    "number": "1346915584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6850",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577096850",
            "telephone_number": "605-341-1414",
            "fax_number": "605-341-7062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4141 5TH ST",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577016021",
            "telephone_number": "605-341-1414",
            "fax_number": "605-341-7062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NORDAHL",
        "first_name": "KENDRA",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-10",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SD",
            "license": "CP002105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENDRA",
            "last_name": "CRISMAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Rapid City, SD

Sources for this page

Verify at the official NPI Registry.