Shakopee Mdewakanton Sioux Community

Primary specialty

AmbulanceTaxonomy code 341600000X

Legal business name

SHAKOPEE MDEWAKANTON SIOUX COMMUNITY

Doing business as

Shakopee Mdewakanton Emergency Services

Practice address

2525 Flandreau Trail
Prior Lake, MN 55372

Phone

(952) 233-1077

NPI assigned

Jul 28, 2006

Organization subpart

No

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

Authorized official

Name

Stanley Crooks

Title

Ceo

Phone

(952) 445-8900

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Shakopee Mdewakanton Emergency Services Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Shakopee Mdewakanton Sioux Community

  dba Shakopee Dakota Clinic

  • Family Medicine Physician
  • Prior Lake, MN
  • NPI 1013933381

  6901861087

  Same PAC ID

Tax ID family

Shakopee Mdewakanton Sioux2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Shakopee Mdewakanton Sioux Community

  dba Shakopee Mdewakanton Sioux Comm Phcy

  • Pharmacy
  • Prior Lake, MN
  • NPI 1437203882
  NPD tax ID

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737331200000",
    "number": "1700890134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3920 13TH AVE E",
            "address_2": "SUITE 6",
            "city": "HIBBING",
            "state": "MN",
            "postal_code": "557463675",
            "telephone_number": "218-263-7540",
            "fax_number": "866-732-0699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 FLANDREAU TRAIL",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "55372",
            "telephone_number": "952-233-1077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAKOPEE MDEWAKANTON SIOUX COMMUNITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-28",
        "last_updated": "2025-01-20",
        "certification_date": "2025-01-20",
        "status": "A",
        "authorized_official_last_name": "CROOKS",
        "authorized_official_first_name": "STANLEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "952-445-8900"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113488400",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "77M49SH",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shakopee Mdewakanton Emergency Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Raymond Lee Seaburg, D.D.S
• Brianna Marie Seawell, DPT
• Nneka Obiajulu Sederstrom, PHD, MPH, MA
• Shakopee Mdewakanton Sioux Community (Shakopee Dakota Clinic)
• Shakopee Mdewakanton Sioux Community (Shakopee Mdewakanton Sioux Comm Phcy)
• Mark Shea
• Shepherds Path Senior Housing,Inc.
• Linda Handelsman Silverman, OT
• Julie Skovran, MT
• Sarah Slater, DNP

• Ambulance in Prior Lake, MN
• Providers in Prior Lake, MN by specialty
• Ambulance in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.