NPIMap

Individual provider Active NPI

Keely Elgethun, M.D.

  • Psychiatry Physician
  • Sioux Falls, SD
National Provider Identifier
1467891929
Registry record updated Jul 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
11312 Issued in SD
Practice address
4400 W 69TH St
Sioux Falls, SD 57108-8170
Phone
(605) 322-4005
NPI assigned
Jun 18, 2013
Last updated
Jul 9, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 125-063744 IL
Psychiatry Physician 2084P0800X 11312 SD Primary

Addresses

Primary practice location

4400 W 69TH St
Sioux Falls, SD 57108-8170

Mailing address

4400 W 69TH St
Sioux Falls, SD 57108

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, SD2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160927002563 IL Practitioner - Psychiatry 7214230424
I20190207000345 SD Practitioner - Psychiatry 7214230424

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Sanford School of Medicine of University of South Dakota, 2013
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

4400 W 69TH St
Suite 1500
Sioux Falls, SD 57108-8171

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125-063744ILMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan Psychiatry CurrentSince Jan 14, 2019 Accepting new patients
Avera McKennan CurrentSince Jan 14, 2019 Accepting new patients
Avera McKennan Current Accepting new patients
Avera McKennan Past Accepting new patients
Avera McKennan Past Accepting new patients

Locations

4400 W 69th St
Sioux Falls, SD 57108
Phone (605) 322-4005

4400 W 69th St
Ste 1500
Sioux Falls, SD 57108
Phone (605) 322-5700

Interoperability endpoints

  • Direct secure messaging: keely.elgethun@avera.sdhealthlink.net

Organizations & group practices 5

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.

  • Avera McKennan

    dba Avera Medical Group University Psychiatry Associates Sioux Falls

    • Psychiatry Physician
    • Sioux Falls, SD
    • NPI 1013980598
    NPD
  • Avera McKennan

    dba Avera Interventional Radiology

    • Diagnostic Radiology Physician
    • Sioux Falls, SD
    • NPI 1053680678
    NPD
  • Avera McKennan

    dba Avera McKennan Behavioral Health Clinic

    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Sioux Falls, SD
    • NPI 1699009944
    NPD
  • Avera McKennan
    • Psychiatric Hospital Unit
    • Sioux Falls, SD
    • NPI 1164445250
    NPD (past)
  • Avera McKennan

    dba Avera McKennan Hospital and University Health Center

    • General Acute Care Hospital
    • Sioux Falls, SD
    • NPI 1568460772
    NPD (past)

Hospital & facility affiliations 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1371513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594252800000",
    "number": "1467891929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 W 69TH ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "57108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 W 69TH ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571088170",
            "telephone_number": "605-322-4005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELGETHUN",
        "first_name": "KEELY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-18",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "125-063744",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "SD",
            "license": "11312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.