Advanced Dermatology of the Black Hills, PC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Legal business name

ADVANCED DERMATOLOGY OF THE BLACK HILLS, PC

Practice address

710 Saint Anne St
Rapid City, SD 57701-4670

Phone

(605) 343-8000

Fax

(605) 343-8262

NPI assigned

Feb 2, 2022

Last updated

Feb 2, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Jonathan Dean Medeck, PA-C

Title

Owner/Physician's Assistant

Phone

(605) 381-6082

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1643760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643760000000",
    "number": "1669125241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1473",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577091473",
            "telephone_number": "605-721-0596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 SAINT ANNE ST",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577014670",
            "telephone_number": "605-343-8000",
            "fax_number": "605-343-8262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DERMATOLOGY OF THE BLACK HILLS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-02",
        "last_updated": "2022-02-02",
        "certification_date": "2022-02-02",
        "status": "A",
        "authorized_official_last_name": "MEDECK",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN'S ASSISTANT",
        "authorized_official_telephone_number": "605-381-6082",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Rapid City, SD
• Providers in Rapid City, SD by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.