NPIMap

Individual provider Active NPI

Jill Waggoner, DNP

  • Nurse Practitioner
  • Sioux Falls, SD
National Provider Identifier
1710482450
Registry record updated Apr 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
CP001353 Issued in SD
Practice address
1309 W 17TH St Ste 101
Sioux Falls, SD 57104-8805
Phone
(605) 328-8000
NPI assigned
Mar 26, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 29, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X CP001353 SD Primary

Addresses

Primary practice location

1309 W 17TH St Ste 101
Sioux Falls, SD 57104-8805

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jwaggoner2543848@direct.sanfordhealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD, IA2 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
I20180726001751 SD Practitioner - Nurse Practitioner 7517214208 Reassigns benefits to 2 organizations
I20231103000494 IA Practitioner - Nurse Practitioner 7517214208 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sanford Medical CenterGroup PAC ID 8325950215, 847 clinicians

Practice addresses (Care Compare)

1305 W 18TH St
Sioux Falls, SD 57105-0401

1309 W 17TH St
Suite G01
Sioux Falls, SD 57104-4664
Phone (605) 312-3400

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.78 of 100Reported as group
Quality
78.77
Promoting interoperability
100
Improvement activities
40
Cost
70.49

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Clinic CurrentSince Dec 3, 2018 Accepting new patients
Sanford Clinic CurrentSince Dec 3, 2018 Accepting new patients
Sanford Clinic Nurse Practitioner Current Accepting new patients
Sanford Medical Center Nurse Practitioner CurrentSince Nov 18, 2019 Accepting new patients
Sanford Clinic Nurse Practitioner Past Accepting new patients

Locations

118 N 7th Ave
Sheldon, IA 51201
Phone (712) 324-5041

1105 E Holly Blvd
Brandon, SD 57005
Phone (605) 582-5820

525 N Foster St
Mitchell, SD 57301
Phone (605) 995-2000

136 S Phillips Ave
Ste 102
Sioux Falls, SD 57104

1500 W 22nd St
Ste 102
Sioux Falls, SD 57105
Phone (605) 328-8800

1305 W 18th St
Sioux Falls, SD 57105
Phone (605) 312-7300

4405 E 26th St
Sioux Falls, SD 57103
Phone (605) 328-9000

1309 W 17th St
Ste 101
Sioux Falls, SD 57104
Phone (605) 328-8000

1309 W 17th St
Ste G01
Sioux Falls, SD 57104
Phone (605) 312-3400

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.

Hospital & facility affiliations 11

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

NPI Registry JSON

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

{
    "created_epoch": "1522022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651190400000",
    "number": "1710482450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1309 W 17TH ST STE 101",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571048805",
            "telephone_number": "605-328-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGGONER",
        "first_name": "JILL",
        "credential": "DNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-03-26",
        "last_updated": "2022-04-29",
        "certification_date": "2022-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SD",
            "license": "CP001353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jwaggoner2543848@direct.sanfordhealth.org",
            "affiliation": "N",
            "address_1": "1309 W 17th St Ste 101",
            "city": "Sioux Falls",
            "state": "SD",
            "country_code": "US",
            "postal_code": "571048805",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.