Individual provider Active NPI

Andrea Nicole Kae, DDS

  • General Practice Dentistry
  • Rapid City, SD
National Provider Identifier
1760375687
Registry record updated May 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN30302 Issued in FL
Practice address
3200 Canyon Lake Dr
Rapid City, SD 57702-8114
Phone
(605) 355-2500
NPI assigned
May 30, 2025
Last updated
May 30, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 30, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN30302 FL Primary

Addresses

Primary practice location

3200 Canyon Lake Dr
Rapid City, SD 57702-8114

Mailing address

4817 Miles Dr
New Orleans, LA 70122-2507
Phone (850) 361-7070

Other names 1

  • Dr. Andrea Nicole Cawthon Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260427000066 TX Practitioner - Dentist 3072080134 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dentist
Education
Other, 2005
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

3200 Canyon Lake Dr
Rapid City, SD 57702-8114

3200 Canyon Lake Dr
Rapid City, SD 57702-8197

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN30302FLMDGeneral Practice Dentistry

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1748563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748563200000",
    "number": "1760375687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4817 MILES DR",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701222507",
            "telephone_number": "850-361-7070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 CANYON LAKE DR",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577028114",
            "telephone_number": "605-355-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAE",
        "first_name": "ANDREA",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-05-30",
        "last_updated": "2025-05-30",
        "certification_date": "2025-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN30302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANDREA",
            "last_name": "CAWTHON",
            "middle_name": "NICOLE",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Rapid City, SD

Sources for this page

Verify at the official NPI Registry.