Jenna Wickersham, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

10716 Issued in SD

Practice address

521 E Sioux Ave
Pierre, SD 57501-3142

Phone

(605) 945-5560

NPI assigned

May 2, 2014

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

At Still University of Health Sciences, College of Osteo Med, Kirksville, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Avera St MarysGroup PAC ID 0143134965, 97 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Avera @ Home Home health agency, Pierre, SD, CCN 437046
• Avera @ Home Hospice, Pierre, SD, CCN 431512
• Avera St Mary'S Hospital Hospital, Pierre, SD, CCN 430015
• Avantara Pierre Nursing home, Pierre, SD, CCN 435047
• Avera Maryhouse Long Term Care Nursing home, Pierre, SD, CCN 435034

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jenna.wickersham@avera.sdhealthlink.net

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.

• Avera St Marys

  • General Acute Care Hospital
  • Pierre, SD
  • NPI 1669457180
  Medicare reassignment Care Compare group NPD
• Avera Gettysburg

  • Critical Access Hospital
  • Gettysburg, SD
  • NPI 1003887266
  Medicare reassignment NPD
• Avera Gettysburg

  • Internal Medicine Physician
  • Gettysburg, SD
  • NPI 1366091357
  Medicare reassignment NPD
• Sanford Clinic

  • Psychologist
  • Sioux Falls, SD
  • NPI 1396764254
  Medicare reassignment NPD
• Avera St Marys

  • Emergency Medicine Physician
  • Pierre, SD
  • NPI 1073305496
  NPD
• Avera St Marys

  • Multi-Specialty Clinic/Center
  • Pierre, SD
  • NPI 1720326713
  NPD
• Sanford Clinic

  • Family Medicine Physician
  • Sioux Falls, SD
  • NPI 1013948439
  NPD
• Sanford Clinic

  • Diagnostic Radiology Physician
  • Fargo, ND
  • NPI 1306641345
  NPD

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

• Avera at Home

  • Home Health Agency
  • Pierre, SD
  • NPI 1336579127
  Care Compare affiliation
• Avera at Home

  • Community Based Hospice Care Agency
  • Pierre, SD
  • NPI 1427488212
  Care Compare affiliation
• Avera St Marys

  • Skilled Nursing Facility
  • Pierre, SD
  • NPI 1063654648

  Nursing home

  Care Compare affiliation
• Avera St Marys

  • General Acute Care Hospital
  • Pierre, SD
  • NPI 1669457180
  Care Compare affiliation
• Avera St Marys

  • Multi-Specialty Clinic/Center
  • Pierre, SD
  • NPI 1720326713

  Hospital

  Care Compare affiliation
• Pierre SD Skilled Nursing Facility LLC

  • Skilled Nursing Facility
  • Pierre, SD
  • NPI 1528624681

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1398988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719360000000",
    "number": "1538579271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 E SIOUX AVE",
            "city": "PIERRE",
            "state": "SD",
            "postal_code": "575013142",
            "telephone_number": "605-945-5560"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1115 E 20th St",
            "address_purpose": "LOCATION",
            "city": "Sioux Falls",
            "state": "SD",
            "postal_code": "571051013",
            "country_code": "US",
            "telephone_number": "605-575-1644",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1115 E 20th St",
            "address_purpose": "LOCATION",
            "city": "Sioux Falls",
            "state": "SD",
            "postal_code": "571051013",
            "country_code": "US",
            "telephone_number": "605-575-1644",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Mac Ln",
            "address_purpose": "LOCATION",
            "city": "Pierre",
            "state": "SD",
            "postal_code": "575013391",
            "country_code": "US",
            "telephone_number": "605-224-5901",
            "fax_number": "605-945-5083",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WICKERSHAM",
        "first_name": "JENNA",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-02",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "0085",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "10716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shon Anthony Weaver, O.D.
• Amy Weller, PT
• Rita L Wendt, RNA
• Jonathan Joseph Werner, MD
• Wendy Whitaker, MSW, CSW, CATC
• Logan McKenzie Widvey, PT
• Kenna Wieczorek, OTD, OTR/L
• Workit Health Mi PLLC
• Joseph O Wyatt, MD
• Kevin Allen Yackley, CRNA

• Family Medicine Physician in Pierre, SD
• Providers in Pierre, 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 Jun 26, 2024; 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.