Michelle Renee Hagen

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0654 Issued in SD

Practice address

113 Comanche Rd
Fort Meade, SD 57741-1002

Phone

(605) 347-2511

NPI assigned

Jul 30, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Black Hills Hospitalist

  • Internal Medicine Physician
  • Rapid City, SD
  • NPI 1073843124
  NPD (past)
• Rushmore Clinic, P.C.

  • Internal Medicine Physician
  • Rapid City, SD
  • NPI 1124184510

  Physician Assistant

  NPD (past)
• U.S. Healthworks Medical Group of Utah, Inc.

  • Preventive Medicine/Occupational Environmental Medicine Physician
  • Seattle, WA
  • NPI 1548240013
  NPD (past)

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

{
    "created_epoch": "1185753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710720000000",
    "number": "1366632002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 COMANCHE RD",
            "city": "FORT MEADE",
            "state": "SD",
            "postal_code": "577411002",
            "telephone_number": "605-347-2511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 COMANCHE RD",
            "city": "FORT MEADE",
            "state": "SD",
            "postal_code": "577411002",
            "telephone_number": "605-347-2511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGEN",
        "first_name": "MICHELLE",
        "middle_name": "RENEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-30",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SD",
            "license": "0654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Rose Guilmett, RN, BSN
• Michael S Guilmett
• David M Gwinn, MD
• Tara Leigh Haas, MD
• Kimberly D Hafeman, PA-C
• Kathleen Rose Haivala, PHARMD
• James Hale, RN
• Bethany Margaret Haley, RN
• Paula K Hambek, RN
• Nathan Hammerstrom, RN

• Physician Assistant in Fort Meade, SD
• Providers in Fort Meade, SD by specialty
• Physician Assistant in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2024; 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.