NPIMap

Individual provider Active NPI

Samuel Max Zollicker, M.D.

  • Family Medicine Physician
  • Brandon, SD
National Provider Identifier
1437507399
Registry record updated Sep 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
11673 Issued in SD
Practice address
1101 E Holly Blvd
Brandon, SD 57005-1426
Phone
(605) 582-3853
Fax
(605) 582-3855
NPI assigned
Jun 1, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2019

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 11673 SD Primary

Addresses

Primary practice location

1101 E Holly Blvd
Brandon, SD 57005-1426

Mailing address

1200 S 7TH Ave
Sioux Falls, SD 57105-0998
Phone (605) 782-8305

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
I20191210000672 SD Practitioner - Family Practice 3375887649 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Kansas Medical College, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera McKennanGroup PAC ID 0345157103, 957 clinicians
Center for Family MedicineGroup PAC ID 2769478429, 16 clinicians
City of Sioux FallsGroup PAC ID 7810943859, 21 clinicians

Practice addresses (Care Compare)

1101 E Holly Blvd
Brandon, SD 57005-1426
Phone (605) 582-3853

1115 E 20TH St
Sioux Falls, SD 57105-1013
Phone (605) 339-1783

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

1910 W 69TH St
Sioux Falls, SD 57108-5612
Phone (605) 322-5200

521 N Main Ave
Suite 100
Sioux Falls, SD 57104-5947
Phone (605) 367-8793

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions11
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11673SDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan Family Medicine CurrentSince Oct 1, 2019 Accepting new patients
City of Sioux Falls CurrentSince Sep 13, 2022 Accepting new patients
City of Sioux Falls Current Accepting new patients
Avera McKennan CurrentSince Oct 1, 2019 Accepting new patients
Center for Family Medicine Family Medicine CurrentSince Apr 1, 2020 Accepting new patients
Avera McKennan Current Accepting new patients
City of Sioux Falls CurrentSince Sep 13, 2022 Accepting new patients
Sanford Medical Center Past Accepting new patients
Avera McKennan Past Accepting new patients

Locations

1101 E Holly Blvd
Brandon, SD 57005
Phone (605) 582-3853

521 N Main Ave
Ste 100
Sioux Falls, SD 57104
Phone (605) 367-8029

1115 E 20th St
Sioux Falls, SD 57105
Phone (605) 339-1783

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

Interoperability endpoints

  • Direct secure messaging: samuel.zollicker@avera.sdhealthlink.net

Organizations & group practices 9

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 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1464739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567555200000",
    "number": "1437507399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 S 7TH AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571050998",
            "telephone_number": "605-782-8305",
            "fax_number": "605-336-1677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 E HOLLY BLVD",
            "city": "BRANDON",
            "state": "SD",
            "postal_code": "570051426",
            "telephone_number": "605-582-3853",
            "fax_number": "605-582-3855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZOLLICKER",
        "first_name": "SAMUEL",
        "middle_name": "MAX",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-01",
        "last_updated": "2019-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "11673",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, SD

Sources for this page

Verify at the official NPI Registry.