NPIMap

Individual provider Active NPI

Jon C Nordgren, PHD

  • Psychologist
  • Sioux Falls, SD
National Provider Identifier
1619024049
Registry record updated Nov 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
340 Issued in SD
Practice address
4400 W 69TH St
Sioux Falls, SD 57108-8170
Phone
(605) 322-4004
Fax
(605) 322-4060
NPI assigned
Jan 5, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 340 SD Primary

Addresses

Primary practice location

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

Mailing address

4400 W 69TH St
Sioux Falls, SD 57108-8170
Phone (605) 322-4004

Other identifiers 5

IdentifierTypeStateIssuer
557412900MedicaidMN
6551372MedicaidSC
4995998OtherSDSD BLUECROSS PROV#
9225136OtherDAKOTACARE
10025015700MedicaidNE

Other names 1

  • Chris Nordgren Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120210000139 SD Practitioner - Clinical Psychologist 4183881618 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Sanford School of Medicine of University of South Dakota, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera McKennanGroup PAC ID 0345157103, 957 clinicians

Practice addresses (Care Compare)

2412 S Cliff Ave
Suite 200
Sioux Falls, SD 57105-4031
Phone (605) 322-4079

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
340SDMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince May 22, 2000 Accepting new patients
Avera McKennan CurrentSince May 22, 2000 Accepting new patients

Locations

300 W 5th St
Miller, SD 57362
Phone (605) 853-0158

3932 S Western Ave
Sioux Falls, SD 57105
Phone (605) 322-6408

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

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

2412 S Cliff Ave
Ste 200
Sioux Falls, SD 57105
Phone (605) 322-4079

Interoperability endpoints

  • Direct secure messaging: chris.nordgren@avera.sdhealthlink.net

Organizations & group practices 2

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.

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": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320969600000",
    "number": "1619024049",
    "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": "571088170",
            "telephone_number": "605-322-4004",
            "fax_number": "605-322-4060"
        },
        {
            "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": "605-322-4004",
            "fax_number": "605-322-4060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NORDGREN",
        "first_name": "JON",
        "middle_name": "C",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-05",
        "last_updated": "2011-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "SD",
            "license": "340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "557412900",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6551372",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SD BLUECROSS PROV#",
            "identifier": "4995998",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAKOTACARE",
            "identifier": "9225136",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025015700",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRIS",
            "last_name": "NORDGREN",
            "credential": "PHD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.