NPIMap

Individual provider Active NPI

Maggie Lynn Bistodeau, PA-C

  • Physician Assistant
  • Tea, SD
National Provider Identifier
1407524622
Registry record updated May 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1331 Issued in SD
Practice address
725 E Figzel CT Ste 100
Tea, SD 57064-2276
Phone
(605) 368-9899
Fax
(605) 368-5089
NPI assigned
Sep 1, 2021
Last updated
May 23, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2025

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 1331 SD Primary

Addresses

Primary practice location

725 E Figzel CT Ste 100
Tea, SD 57064-2276

Mailing address

725 E Figzel CT Ste 100
Tea, SD 57064-2276
Phone (605) 368-9899

Other identifiers 1

IdentifierTypeStateIssuer
1331OtherSDSDBMOE

Other names 1

  • Maggie Lynn Donovan Former name

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
I20211115002350 SD Practitioner - Physician Assistant 7214326198 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera McKennanGroup PAC ID 0345157103, 957 clinicians

Practice addresses (Care Compare)

1200 S 7TH Ave
Sioux Falls, SD 57105-0900
Phone (605) 336-2140

2100 S Marion Rd
Sioux Falls, SD 57106-3646
Phone (605) 322-5180

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince Jul 17, 2023 Accepting new patients
Avera St Marys CurrentSince Jan 1, 2022 Accepting new patients
City of Brookings Current Accepting new patients
Avera McKennan Physician Assistant CurrentSince Jul 17, 2023 Accepting new patients
City of Brookings CurrentSince Jun 25, 2023 Accepting new patients
City of Brookings CurrentSince Jun 25, 2023 Accepting new patients

Locations

300 22nd Ave
Brookings, SD 57006
Phone (605) 692-6351

1200 S 7th Ave
Sioux Falls, SD 57105
Phone (605) 336-2140

725 E Figzel Ct
Ste 100
Tea, SD 57064
Phone (605) 368-9899

401 9th Ave NW
Watertown, SD 57201
Phone (605) 886-9317

506 1st Ave SE
Watertown, SD 57201
Phone (605) 884-4247

Interoperability endpoints

  • Direct secure messaging: maggie.bistodeau@avera.sdhealthlink.net

Organizations & group practices 11

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 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": "1630454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747958400000",
    "number": "1407524622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 E FIGZEL CT STE 100",
            "city": "TEA",
            "state": "SD",
            "postal_code": "570642276",
            "telephone_number": "605-368-9899",
            "fax_number": "605-368-5089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 E FIGZEL CT STE 100",
            "city": "TEA",
            "state": "SD",
            "postal_code": "570642276",
            "telephone_number": "605-368-9899",
            "fax_number": "605-368-5089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BISTODEAU",
        "first_name": "MAGGIE",
        "middle_name": "LYNN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-01",
        "last_updated": "2025-05-23",
        "certification_date": "2025-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SD",
            "license": "1331",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SDBMOE",
            "identifier": "1331",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MAGGIE",
            "last_name": "DONOVAN",
            "middle_name": "LYNN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tea, SD

Sources for this page

Verify at the official NPI Registry.