Kim Pederson, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

1256 Issued in SD

Practice address

2100 S Marion Rd
Sioux Falls, SD 57106

Phone

(605) 322-1010

Fax

(605) 322-1011

NPI assigned

Jun 18, 2006

Last updated

May 15, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Freeman Regional Health Services

  • Rural Health Clinic/Center
  • Marion, SD
  • NPI 1740570076
  NPD (past)

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526342400000",
    "number": "1487699971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 86430",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571186430",
            "telephone_number": "605-322-4900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 S MARION RD",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "57106",
            "telephone_number": "605-322-1010",
            "fax_number": "605-322-1011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSON",
        "first_name": "KIM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-18",
        "last_updated": "2018-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "1256",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5603282",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shannon R Peck, M.D.
• Nicole Maria Pedersen
• Cole Jason Pederson, COTA
• Jeanette Zespy Pederson, OTR/L
• Kalli Pederson, RDN, LN, CDE
• Pediatric Dentistry, Inc.
• Pediatric Hematology Clinic LTD
• Pediatric Hematology Oncology Pharmacy LTC
• Pediatric Sedation Dentistry of Colorado PLLC
• Pediatric Surgical Associates PC

• Family Medicine Physician in Sioux Falls, SD
• Providers in Sioux Falls, SD by specialty
• Family Medicine Physician in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.