Active NPI
Paula Ann Hicks, M.D.
- Ophthalmology Physician
- Yankton, SD
National Provider Identifier
1407859341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 3820
- Practice address
- 415 W 3Rd St
Yankton, SD 57078-4201 - Phone
- (605) 665-9638
- Fax
- (605) 665-0526
- NPI assigned
- May 24, 2005
- Last updated
- Nov 4, 2008
- 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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 3820 | SD | Primary |
| Ophthalmology Physician | 207W00000X | 19498 | NE |
Addresses
Primary practice location
415 W 3Rd St
Yankton, SD 57078-4201
Mailing address
PO Box 819
Yankton, SD 57078-0819
Phone (605) 665-9638
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 36-3050195-13 | Medicaid | SD | |
| NA1114001 | Other | NE | NE MEDICARE PTAN NORFOLK, NE |
| 0003388 | Other | SD | SD WELLMARK BLUE SHIELD |
| 3820 | Other | SD | DAKOTACARE PROVIDER ID |
| NA1115001 | Other | NE | NE MEDICARE PTAN WAYNE, NE |
| 36-3050195-14 | Medicaid | NE | |
| 22053 | Other | NE | NE BLUE SHIELD |
| 6300100 | Medicaid | SD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3820 | SD | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1116892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225756800000",
"number": "1407859341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 819",
"city": "YANKTON",
"state": "SD",
"postal_code": "570780819",
"telephone_number": "605-665-9638",
"fax_number": "605-665-0526"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "415 W 3RD ST",
"city": "YANKTON",
"state": "SD",
"postal_code": "570784201",
"telephone_number": "605-665-9638",
"fax_number": "605-665-0526"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HICKS",
"first_name": "PAULA",
"middle_name": "ANN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-05-24",
"last_updated": "2008-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "SD",
"license": "3820",
"primary": true
},
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "NE",
"license": "19498",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "36-3050195-13",
"state": "SD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NE MEDICARE PTAN NORFOLK, NE",
"identifier": "NA1114001",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SD WELLMARK BLUE SHIELD",
"identifier": "0003388",
"state": "SD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DAKOTACARE PROVIDER ID",
"identifier": "3820",
"state": "SD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NE MEDICARE PTAN WAYNE, NE",
"identifier": "NA1115001",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "36-3050195-14",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NE BLUE SHIELD",
"identifier": "22053",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6300100",
"state": "SD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Yankton, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.