NPIMap

Individual provider Active NPI

Avery Lyne Sides, M.D.

  • Family Medicine Physician
  • Hot Springs, SD
National Provider Identifier
1629360342
Registry record updated Mar 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1481 Issued in SD
Practice address
1201 Highway 71 S
Fall River Health Services
Hot Springs, SD 57747-8800
Phone
(605) 745-8910
NPI assigned
May 12, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 6455 NE
Family Medicine Physician 207Q00000X 1481 SD Primary

Addresses

Primary practice location

1201 Highway 71 S
Fall River Health Services
Hot Springs, SD 57747-8800

Mailing address

1201 Highway 71 S
Fall River Health Services
Hot Springs, SD 57747-8800
Phone (605) 745-8910

Other names 1

  • Avery L Shaw Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20141006001990 SD Practitioner - Family Practice 4688894017 Reassigns benefits to 2 organizations
I20170624000172 TX Practitioner - Family Practice 4688894017 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Nebraska College of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Monument Health Network IncGroup PAC ID 5991616427, shared by 12 NPIs, 163 clinicians

Practice addresses (Care Compare)

1220 Montgomery St
Custer, SD 57730-1705
Phone (605) 673-4150

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.78 of 100Reported as apm
Quality
80.38
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6455NEMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Monument Health Network, Inc. CurrentSince Jul 1, 2021 Accepting new patients
Pine Ridge Indian Health Service Hospital CurrentSince Apr 22, 2017 Accepting new patients
Monument Health Network, Inc. Current Accepting new patients
Pine Ridge Indian Health Service Hospital Current Accepting new patients
Pine Ridge Indian Health Service Hospital CurrentSince Apr 22, 2017 Accepting new patients
Monument Health Network, Inc. Family Medicine CurrentSince Jul 1, 2021 Accepting new patients
Monument Health Network, Inc CurrentSince Dec 19, 2024 Accepting new patients
Queen City Regional Medical Clinic Past Accepting new patients

Locations

1220 Montgomery St
Custer, SD 57730
Phone (605) 673-4150

1440 N Main St
Spearfish, SD 57783
Phone (605) 644-4000

2140 Junction Ave
Sturgis, SD 57785
Phone (605) 720-2400

Interoperability endpoints

  • Direct secure messaging: asides.24105@regionalhealth.sdhealthlink.net

Organizations & group practices 8

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 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1305158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427068800000",
    "number": "1629360342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 HIGHWAY 71 S",
            "address_2": "FALL RIVER HEALTH SERVICES",
            "city": "HOT SPRINGS",
            "state": "SD",
            "postal_code": "577478800",
            "telephone_number": "605-745-8910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 HIGHWAY 71 S",
            "address_2": "FALL RIVER HEALTH SERVICES",
            "city": "HOT SPRINGS",
            "state": "SD",
            "postal_code": "577478800",
            "telephone_number": "605-745-8910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDES",
        "first_name": "AVERY",
        "middle_name": "LYNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-12",
        "last_updated": "2015-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "6455",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "1481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AVERY",
            "last_name": "SHAW",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Hot Springs, SD

Sources for this page

Verify at the official NPI Registry.