NPIMap

Individual provider Active NPI

Jason Domagalski, PA

  • Physician Assistant
  • Sioux Falls, SD
National Provider Identifier
1710930664
Registry record updated Aug 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0483 Issued in SD
Practice address
2501 W 22ND St
Sioux Falls, SD 57105
Phone
(605) 336-3230
NPI assigned
May 19, 2006
Last updated
Aug 10, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2018

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 0483 SD Primary

Addresses

Primary practice location

2501 W 22ND St
Sioux Falls, SD 57105

Mailing address

5201 S Mandy Ave
Sioux Falls, SD 57106-2860
Phone (605) 323-2831

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD, MN2 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
I20070402000320 SD Practitioner - Physician Assistant 4688778616 Reassigns benefits to 1 organization
I20121102000124 MN Practitioner - Physician Assistant 4688778616 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
City of BrookingsGroup PAC ID 1052307105, 112 clinicians
Madison Healthcare ServicesGroup PAC ID 9638080187, 29 clinicians
Lac Qui Parle Clinic of Madison IncGroup PAC ID 5799727707, 15 clinicians

Practice addresses (Care Compare)

300 22ND Ave
Brookings, SD 57006-2480
Phone (605) 692-6351

820 3Rd Ave
Madison, MN 56256-1014
Phone 32059875517551

900 2ND Ave
Madison, MN 56256-1006
Phone 32059875517158

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11119MNMDClinical Social Worker
0483SDMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
City of Brookings Current Accepting new patients
Sanford Health Network CurrentSince Jul 1, 2013 Accepting new patients
City of Brookings CurrentSince Jan 22, 2018 Accepting new patients
Hendricks Community Hospital Assn & Retirement Home Past Accepting new patients
Sanford Health Network PastSince Jun 28, 2020 Accepting new patients
Maine Urgent Care, LLC Past Accepting new patients

Locations

300 22nd Ave
Brookings, SD 57006
Phone (605) 692-6351

400 22nd Ave
Brookings, SD 57006
Phone (605) 692-6236

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533859200000",
    "number": "1710930664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5201 S MANDY AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571062860",
            "telephone_number": "605-323-2831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 W 22ND ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "57105",
            "telephone_number": "605-336-3230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMAGALSKI",
        "first_name": "JASON",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2018-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SD",
            "license": "0483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.