Active NPI
Michelle Rae Wanna, MD
- Dermatology Physician
- Sioux Falls, SD
National Provider Identifier
1386754307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 7571
- Practice address
- 6701 S Minnesota Ave
Sioux Falls, SD 57108-2591 - Phone
- (605) 322-6960
- Fax
- (605) 322-6961
- NPI assigned
- Aug 30, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 7571 | SD | Primary |
| Dermatology Physician | 207N00000X | 2006012197 | MO |
Addresses
Primary practice location
6701 S Minnesota Ave
Sioux Falls, SD 57108-2591
Mailing address
PO Box 86370
Sioux Falls, SD 57118-6370
Phone (605) 322-7510
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5900570 | Medicaid | SD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Dermatology
- Education
- Sanford School of Medicine of University of South Dakota, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2100 S Marion Rd
Sioux Falls, SD 57106-3646
Phone (605) 322-5180
2100 S Marion Rd
Sioux Falls, SD 57106-3650
6701 S Minnesota Ave
Sioux Falls, SD 57108-2591
Phone (605) 322-6960
Hospital & facility affiliations
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
| Removal of skin lesions | 969 |
| Removal or shaving of skin growth | 37 |
| Skin biopsy | 464 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2006012197 | MO | MD | Dermatology Physician |
| 7571 | SD | MD | Dermatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Avera McKennan | Current | Accepting new patients | |
| Avera McKennan | Dermatology | Current | Accepting new patients |
| Avera McKennan | Current | Accepting new patients |
Locations
6701 S Minnesota Ave
Sioux Falls, SD 57108
Phone (605) 322-6960
Interoperability endpoints
- michelle.wanna@avera.sdhealthlink.net
Organizations & group practices 3
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Sioux Falls, SD
- NPI 1699009944
-
- Diagnostic Radiology Physician
- Sioux Falls, SD
- NPI 1053680678
-
- Dermatology Physician
- Sioux Falls, SD
- NPI 1346216074
Hospital & facility affiliations 23
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Sioux Falls, SD
- NPI 1154531630
-
- General Acute Care Hospital
- Sioux Falls, SD
- NPI 1184834764
-
- Endocrinology, Diabetes & Metabolism Physician
- Sioux Falls, SD
- NPI 1396711016
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539561600000",
"number": "1386754307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 86370",
"city": "SIOUX FALLS",
"state": "SD",
"postal_code": "571186370",
"telephone_number": "605-322-7510",
"fax_number": "605-322-6475"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6701 S MINNESOTA AVE",
"city": "SIOUX FALLS",
"state": "SD",
"postal_code": "571082591",
"telephone_number": "605-322-6960",
"fax_number": "605-322-6961"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WANNA",
"first_name": "MICHELLE",
"middle_name": "RAE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2018-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "SD",
"license": "7571",
"primary": true
},
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "MO",
"license": "2006012197",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5900570",
"state": "SD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sioux Falls, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2018; 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.