Mary Beth Dornheim, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

19740 Issued in MN

Practice address

2400 W 49TH St
Sioux Falls, SD 57105-6581

Phone

(605) 312-8700

NPI assigned

Jan 29, 2007

Last updated

May 28, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in SD

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Sanford Medical CenterGroup PAC ID 8325950215, 847 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sanford Usd Medical Center Hospital, Sioux Falls, SD, CCN 430027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: marybeth.dornheim@avera.sdhealthlink.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sanford Medical Center

  dba Edith Sanford Breast Specialty Clinic

  • Family Medicine Physician
  • Sioux Falls, SD
  • NPI 1093090342
  Medicare reassignment Care Compare group NPD
• Avera McKennan

  dba Avera McKennan Behavioral Health Clinic

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

  dba Avera Interventional Radiology

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

  dba Avera Medical Group Behavioral Health Clinic

  • Psychiatry Physician
  • Sioux Falls, SD
  • NPI 1760933261
  NPD

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

• Sanford Medical Center

  dba Sanford USD Medical Center

  • Air Ambulance
  • Sioux Falls, SD
  • NPI 1023299708

  Hospital

  Care Compare affiliation
• Sanford Medical Center

  dba Edith Sanford Breast Specialty Clinic

  • Family Medicine Physician
  • Sioux Falls, SD
  • NPI 1093090342

  Hospital

  Care Compare affiliation
• Sanford Medical Center

  dba Sanford USD Medical Center

  • General Acute Care Hospital
  • Sioux Falls, SD
  • NPI 1821017880
  Care Compare affiliation

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716854400000",
    "number": "1356487227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 W 49TH ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571056581",
            "telephone_number": "605-312-8700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 E 21st St",
            "address_purpose": "LOCATION",
            "city": "Sioux Falls",
            "state": "SD",
            "postal_code": "571051016",
            "country_code": "US",
            "telephone_number": "605-322-4005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DORNHEIM",
        "first_name": "MARY BETH",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-29",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "173889",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "SD",
            "license": "4781",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "19740",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEATH PARTNERS",
            "identifier": "1356487227",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MINNESOTA HEALTH CARE PROGRAMS",
            "identifier": "330617000",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UBH MEDICA",
            "identifier": "000498910",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Catherine Doom-Anderson, FNP-BC
• Jennifer Doom
• Joshua Michael Doorn, M.D.
• Jedidiah Emanuel Dooyema, ATC
• James David Dorman, D.C.
• Shaun Michael Dorothy, D.C.
• Sarah Dorr, APRN
• Jose Marius D Dosado, M.D.
• John Dosch
• Wade E Dosch, M.D.

• Clinical Social Worker in Sioux Falls, SD
• Providers in Sioux Falls, SD by specialty
• Clinical Social Worker in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 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.
• 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.