NPIMap

Organization Active NPI

Destiny Healthcare International, Inc

  • Family Medicine Physician
  • Sioux Falls, SD
National Provider Identifier
1356369995
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1799 Issued in SD
Legal business name
DESTINY HEALTHCARE INTERNATIONAL, INC
Practice address
1417 S Minnesota Ave
Sioux Falls, SD 57105-1715
Phone
(605) 339-3378
Fax
(605) 339-0710
NPI assigned
Jul 18, 2006
Last updated
Mar 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Dr. Brian K Kidman, M.D.NPI 1699788281
Title
Executive Director
Phone
(605) 339-3378

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 1799 SD Primary

Addresses

Primary practice location

1417 S Minnesota Ave
Sioux Falls, SD 57105-1715

Mailing address

1417 S Minnesota Ave
Sioux Falls, SD 57105-1715
Phone (605) 339-3378

Other practice location 1

2701 S Minnesota Ave
Suite 3
Sioux Falls, SD 57105-4744
Phone (605) 339-3378

Other identifiers 2

IdentifierTypeStateIssuer
5604647MedicaidSD
6701870MedicaidSD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1356369995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1417 S MINNESOTA AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051715",
            "telephone_number": "605-339-3378",
            "fax_number": "605-339-0710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1417 S MINNESOTA AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051715",
            "telephone_number": "605-339-3378",
            "fax_number": "605-339-0710"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2701 S Minnesota Ave",
            "address_2": "Suite 3",
            "address_purpose": "LOCATION",
            "city": "Sioux Falls",
            "state": "SD",
            "postal_code": "571054744",
            "country_code": "US",
            "telephone_number": "605-339-3378",
            "fax_number": "605-339-0710",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DESTINY HEALTHCARE INTERNATIONAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-18",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "KIDMAN",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "605-339-3378",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "1799",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5604647",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6701870",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.