Dustin Brooks Tanner, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY-202804 Issued in ID

Practice address

910 W Havens Ave
Mitchell, SD 57301-3831

Phone

(605) 996-9686

Fax

(605) 996-1624

NPI assigned

Feb 23, 2009

Last updated

Aug 5, 2015By 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 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Alliance Family Services IncGroup PAC ID 6800011438, 8 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.

• Alliance Family Services, Inc.

  • Community/Behavioral Health Agency
  • Twin Falls, ID
  • NPI 1104942218
  Medicare reassignment Care Compare group NPD
• Abbott House, Inc.

  • Psychiatric Residential Treatment Facility
  • Mitchell, SD
  • NPI 1053526673
  NPD (past)
• Life Light Counseling, Inc.

  • Community/Behavioral Health Agency
  • Mitchell, SD
  • NPI 1649343922
  NPD (past)
• Alliance Family Services North, Inc,

  • Community/Behavioral Health Agency
  • Kellogg, ID
  • NPI 1447473863
  NPD (past)

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

{
    "created_epoch": "1235347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438732800000",
    "number": "1497995088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2070 NORTHERN SKY DR",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833013900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 W HAVENS AVE",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573013831",
            "telephone_number": "605-996-9686",
            "fax_number": "605-996-1624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANNER",
        "first_name": "DUSTIN",
        "middle_name": "BROOKS",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-23",
        "last_updated": "2015-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "ID",
            "license": "PSY-202804",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "SD",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5200110",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca Ann Studelska, D.C.
• Tiffany Jeanne Stuelpnagel, O.T.
• Trent Allen Suckut, MAT, ATC
• Lyle Sutherland
• Jason Daniel Swindler, B.S.
• Jennifer Lee Tegethoff, MD
• Brian Leroy Temple
• Tender Hearts
• Lisa L Thelen, PHARM D
• Theresa M Campbell PC

• Clinical Psychologist in Mitchell, SD
• Providers in Mitchell, SD by specialty
• Clinical Psychologist in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.