NPIMap

Individual provider Active NPI

Kaci Park, PA-C

  • Physician Assistant
  • Sioux Falls, SD
National Provider Identifier
1376129841
Registry record updated Mar 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1000 E 23Rd St Ste 360
Sioux Falls, SD 57105-2140
Phone
(605) 322-3950
NPI assigned
Mar 23, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

1000 E 23Rd St Ste 360
Sioux Falls, SD 57105-2140

Mailing address

1000 E 23Rd St Ste 360
Sioux Falls, SD 57105-2140
Phone (605) 322-3950

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210713002690 SD Practitioner - Physician Assistant 5991107955 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera McKennanGroup PAC ID 0345157103, 957 clinicians

Practice addresses (Care Compare)

1000 E 23Rd St
Sioux Falls, SD 57105-2114

1001 E 21St St
Suite 401
Sioux Falls, SD 57105-1017
Phone (605) 322-8920

1325 S Cliff Ave
Sioux Falls, SD 57105-1007

1417 S Cliff Ave
Suite 401
Sioux Falls, SD 57105-1064
Phone (605) 322-8920

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1287SDMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Health Network CurrentSince Jun 14, 2021 Accepting new patients
Avera McKennan CurrentSince Jun 1, 2021 Accepting new patients
Sanford Health Network CurrentSince Jun 14, 2021 Accepting new patients
Avera McKennan CurrentSince Jun 1, 2021 Accepting new patients
Avera McKennan Physician Assistant Past Accepting new patients

Locations

400 N Hiawatha Dr
Canton, SD 57013
Phone (605) 764-1500

300 S Byron Blvd
Chamberlain, SD 57325
Phone (605) 234-5511

701 3rd Ave S
Clear Lake, SD 57226
Phone (605) 874-2141

1000 E 23rd St
Ste 360
Sioux Falls, SD 57105
Phone (605) 322-3950

1417 S Cliff Ave
Ste 401
Sioux Falls, SD 57105
Phone (605) 322-8920

Interoperability endpoints

  • Direct secure messaging: kaci.park@avera.sdhealthlink.net

Organizations & group practices 7

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.

Hospital & facility affiliations 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1616457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679356800000",
    "number": "1376129841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 E 23RD ST STE 360",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571052140",
            "telephone_number": "605-322-3950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E 23RD ST STE 360",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571052140",
            "telephone_number": "605-322-3950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "KACI",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-23",
        "last_updated": "2023-03-21",
        "certification_date": "2023-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.