NPIMap

Individual provider Active NPI

Reta Ann Bearface, PHYSICIAN ASSISTANT

  • Physician Assistant
  • Kyle, SD
National Provider Identifier
1679580872
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0608 Issued in SD
Practice address
1000 Health Center Road
Kyle, SD 57752-0540
Phone
(605) 455-2451
Fax
(605) 455-1529
NPI assigned
Aug 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0608 SD Primary

Addresses

Primary practice location

1000 Health Center Road
Kyle, SD 57752-0540

Mailing address

1000 Health Center Road
PO Box 540
Kyle, SD 57752-0540
Phone (605) 455-2451

Other practice location 1

Rosebud IHS Indian Hospital
Soldier Creek Road
Rosebud, SD 57570-0400
Phone (605) 747-2194

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0608SDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Santa Clara Health Center PastSince Jan 19, 2012 Accepting new patients
San Felipe Health Clinic Past Accepting new patients
Rosebud Indian Health Service Past Accepting new patients
Cochiti Health Clinic Past Accepting new patients
Santo Domingo Health Clinic Past Accepting new patients

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1679580872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 HEALTH CENTER ROAD",
            "address_2": "PO BOX 540",
            "city": "KYLE",
            "state": "SD",
            "postal_code": "577520540",
            "telephone_number": "605-455-2451",
            "fax_number": "605-455-1529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 HEALTH CENTER ROAD",
            "city": "KYLE",
            "state": "SD",
            "postal_code": "577520540",
            "telephone_number": "605-455-2451",
            "fax_number": "605-455-1529"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "ROSEBUD IHS INDIAN HOSPITAL",
            "address_2": "SOLDIER CREEK ROAD",
            "address_purpose": "LOCATION",
            "city": "ROSEBUD",
            "state": "SD",
            "postal_code": "575700400",
            "country_code": "US",
            "telephone_number": "605-747-2194",
            "fax_number": "605-747-5348",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BEARFACE",
        "first_name": "RETA",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-01",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SD",
            "license": "0608",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kyle, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.