NPIMap

Individual provider Active NPI

Blake Wadsworth

  • Family Medicine Physician
  • Rapid City, SD
National Provider Identifier
1417699919
Registry record updated Jul 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
17531 Issued in SD
Practice address
2526 Elderberry Boulevard
Rapid City, SD 57703
Phone
(605) 755-1000
NPI assigned
Apr 13, 2022
Last updated
Jul 23, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 17531 SD Primary

Addresses

Primary practice location

2526 Elderberry Boulevard
Rapid City, SD 57703

Mailing address

2526 Elderberry Boulevard
Rapid City, SD 57703

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
I20251016002056 SD Practitioner - Family Practice 5597147983 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Lake Erie College of Osteopathic Medicine, Erie, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1303 N Lacrosse St
Rapid City, SD 57701-6956
Phone (605) 755-6600

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
17531SDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Monument Health Rapid City Hospital Inc CurrentSince Sep 1, 2025 Accepting new patients
Monument Health Rapid City Hospital, Inc. Family Medicine CurrentSince Sep 1, 2025 Accepting new patients
Monument Health Rapid City Hospital, Inc Current Accepting new patients
Monument Health Rapid City Hospital, Inc. Past Accepting new patients

Locations

375 Berky Dr
Box Elder, SD 57719

1303 N Lacrosse St
Rapid City, SD 57701
Phone (605) 755-6600

2116 Jackson Blvd
Rapid City, SD 57702
Phone (605) 755-3300

2526 Elderberry Blvd
Rapid City, SD 57703

353 Fairmont Blvd
Rapid City, SD 57701
Phone (605) 719-1000

502 E Monroe St
Rapid City, SD 57701
Phone (605) 719-4060

Organizations & group practices 4

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1649808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753228800000",
    "number": "1417699919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2526 ELDERBERRY BOULEVARD",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "57703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2526 ELDERBERRY BOULEVARD",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "57703",
            "telephone_number": "605-755-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADSWORTH",
        "first_name": "BLAKE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-13",
        "last_updated": "2025-07-23",
        "certification_date": "2025-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "17531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rapid City, SD

Sources for this page

Verify at the official NPI Registry.