Organization Active NPI

Nebelsick Optometric PLLC

  • Optometrist
  • Rapid City, SD
National Provider Identifier
1366288219
Registry record updated Jul 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
NEBELSICK OPTOMETRIC PLLC
Practice address
409 Kansas City St
Rapid City, SD 57701-3636
Phone
(605) 348-2323
Fax
(605) 348-6694
NPI assigned
Jul 1, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2024

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

Authorized official

Name
Jonathan Paul Nebelsick, ODNPI 1659926160
Title
Owner
Phone
(605) 999-0152

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

409 Kansas City St
Rapid City, SD 57701-3636

Mailing address

23811 Kieffer Ranch Rd
Rapid City, SD 57702-7369
Phone (605) 999-0152

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241021004361 SD Part B Supplier - Clinic/Group Practice 5193257798 Receives reassigned benefits from 1 practitioner
Practice locations: Rapid City, SD

National Provider Directory

National Provider Directory

Locations

409 Kansas City St
Rapid City, SD 57701
Phone (605) 348-2323

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1719792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719792000000",
    "number": "1366288219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23811 KIEFFER RANCH RD",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577027369",
            "telephone_number": "605-999-0152",
            "fax_number": "605-348-6694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 KANSAS CITY ST",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577013636",
            "telephone_number": "605-348-2323",
            "fax_number": "605-348-6694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEBELSICK OPTOMETRIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-01",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A",
        "authorized_official_last_name": "NEBELSICK",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "605-999-0152",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Jul 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.