NPIMap

Individual provider Active NPI

Susan J Walden, FNP-C

  • Nurse Practitioner
  • Kyle, SD
National Provider Identifier
1376041426
Registry record updated Feb 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN256011 Issued in GA
Practice address
1000 Health Center Road
Kyle, SD 57752
Phone
(605) 455-2451
NPI assigned
Jan 24, 2018
Last updated
Feb 9, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2024

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN256011 GA Primary
Registered Nurse 163W00000X RN256011 GA
Case Management Registered Nurse 163WC0400X RN256011 GA
Nurse Practitioner 363L00000X CP002059 SD
Nurse Practitioner 363L00000X RN256001 GA

Addresses

Primary practice location

1000 Health Center Road
Kyle, SD 57752

Mailing address

27 Wapiyapi Ave
Kyle, SD 57752-3115
Phone (605) 455-2451

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, TX2 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
I20181029000175 GA Practitioner - Nurse Practitioner 2062764830
I20210802001632 TX Practitioner - Nurse Practitioner 2062764830 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pine Ridge Indian Health Service HospitalGroup PAC ID 7214825371, 10 clinicians
Pine Ridge Indian Health Service HospitalGroup PAC ID 4688654130, 8 clinicians

Practice addresses (Care Compare)

1000 Health Ctr Rd
Kyle, SD 57752-0540
Phone (604) 455-2451

119 S 1St Ave
Martin, SD 57551-5835
Phone (605) 867-3313

210 E 1St St
Wanblee, SD 57577-0290
Phone (605) 462-6155

East Hwy 18
Pine Ridge, SD 57770-1201
Phone (605) 867-3032

P O Box
Suite 1201
Pine Ridge, SD 57770-1201

P O Box 1201 E Hwy 18
Pine Ridge, SD 57770-1201

PO Box 1201 E Hwy 18
Pine Ridge, SD 57770-1201

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.38 of 100Reported as group
Quality
80.82
Promoting interoperability
91
Improvement activities
40
Cost
84.44

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN256001GAMDNurse Practitioner
CP002059SDMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Ridge Indian Health Service Hospital Current Accepting new patients
Pine Ridge Indian Health Service Hospital CurrentSince Jun 30, 2021 Accepting new patients
Pine Ridge Indian Health Service Hospital CurrentSince Jun 30, 2021 Accepting new patients
Pine Ridge Indian Health Service Hospital Current Accepting new patients
Pine Ridge Indian Health Service Hospital CurrentSince Jun 30, 2021 Accepting new patients

Locations

119 S 1st Ave
Martin, SD 57551
Phone (605) 685-2800

Organizations & group practices 5

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1516752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707436800000",
    "number": "1376041426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 WAPIYAPI AVE",
            "city": "KYLE",
            "state": "SD",
            "postal_code": "577523115",
            "telephone_number": "605-455-2451",
            "fax_number": "706-774-7230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 HEALTH CENTER ROAD",
            "city": "KYLE",
            "state": "SD",
            "postal_code": "57752",
            "telephone_number": "605-455-2451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDEN",
        "first_name": "SUSAN",
        "middle_name": "J",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-24",
        "last_updated": "2024-02-09",
        "certification_date": "2024-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN256011",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN256011",
            "primary": false
        },
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": "GA",
            "license": "RN256011",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SD",
            "license": "CP002059",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN256001",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kyle, SD

Sources for this page

Verify at the official NPI Registry.