Staci A.G. Wietfeld, DPT, OCS

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1370 Issued in SD

Practice address

1100 E 21St St Ste 402
Sioux Falls, SD 57105-1000

Phone

(605) 322-5080

Fax

(605) 322-5085

NPI assigned

Aug 29, 2008

Last updated

Aug 29, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Avera McKennanGroup PAC ID 0345157103, 957 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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 McKennan Behavioral Health Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Sioux Falls, SD
  • NPI 1699009944
  Medicare reassignment Care Compare group NPD
• Avera McKennan

  dba Avera Interventional Radiology

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

  dba Avera McKennan Hospital and University Health Center

  • General Acute Care Hospital
  • Sioux Falls, SD
  • NPI 1568460772
  NPD
• Avera McKennan

  dba Avera Medical Group

  • Family Medicine Physician
  • Sioux Falls, SD
  • NPI 1376575514
  NPD (past)

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

{
    "created_epoch": "1219968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219968000000",
    "number": "1487802641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 E 21ST ST STE 402",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051000",
            "telephone_number": "605-322-5080",
            "fax_number": "605-322-5085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 E 21ST ST STE 402",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051000",
            "telephone_number": "605-322-5080",
            "fax_number": "605-322-5085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIETFELD",
        "first_name": "STACI",
        "middle_name": "A.G.",
        "name_prefix": "Ms.",
        "credential": "DPT, OCS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-29",
        "last_updated": "2008-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SD",
            "license": "1370",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "6094",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Wienk, PT, SCD
• Daryl R Wierda, MD
• Jennifer Mae Wiese, MA, LPC-MH, LAC
• Melissa Wiese, LPC, ACT
• Megan Mattie Wiessner, M.A., CFY-SLP
• Wiggers Counseling LLC
• Tyson Wiggers, CSW-PIP, QMHP
• Ashley Jean Wilcox, CSW-PIP
• Kelsi Wilcox, CSW-PIP
• Melissa Ann Wilcoxon, RDN, LN

• Physical Therapist in Sioux Falls, SD
• Providers in Sioux Falls, SD by specialty
• Physical Therapist in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.