NPIMap

Individual provider Active NPI

Thomas Rauby Shaffer, PH.D.

  • Clinical Neuropsychologist
  • Brookings, SD
National Provider Identifier
1770749442
Registry record updated Jul 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
472 Issued in SD
Practice address
1310 Main Ave S
Suite 9
Brookings, SD 57006-3819
Phone
(605) 692-6367
Fax
(605) 692-1883
NPI assigned
Aug 1, 2008
Last updated
Jul 14, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 14, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 472 SD Primary

Addresses

Primary practice location

1310 Main Ave S
Suite 9
Brookings, SD 57006-3819

Mailing address

PO Box 931
Brookings, SD 57006-0931
Phone (605) 695-0651

Other identifiers 2

IdentifierTypeStateIssuer
S102729OtherMEDICARE PTAN/ID
6552660MedicaidSD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081006000705 SD Practitioner - Psychologist Billing Independently 9234206467 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera McKennanGroup PAC ID 0345157103, 957 clinicians

Practice addresses (Care Compare)

2412 S Cliff Ave
Suite 200
Sioux Falls, SD 57105-4031
Phone (605) 322-4079

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince May 5, 2015 Accepting new patients
Avera McKennan CurrentSince May 5, 2015 Accepting new patients
Avera McKennan Current Accepting new patients
Neuropsychology Consultants LLC Clinical Neuropsychologist PastSince Jan 1, 2012 Accepting new patients

Locations

300 W 5th St
Miller, SD 57362
Phone (605) 853-0158

2412 S Cliff Ave
Ste 200
Sioux Falls, SD 57105
Phone (605) 322-4079

3932 S Western Ave
Sioux Falls, SD 57105
Phone (605) 322-6408

Interoperability endpoints

  • Direct secure messaging: thomas.shaffer@avera.sdhealthlink.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1217548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405296000000",
    "number": "1770749442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 931",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "570060931",
            "telephone_number": "605-695-0651",
            "fax_number": "605-692-1883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 MAIN AVE S",
            "address_2": "SUITE 9",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "570063819",
            "telephone_number": "605-692-6367",
            "fax_number": "605-692-1883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAFFER",
        "first_name": "THOMAS",
        "middle_name": "RAUBY",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-01",
        "last_updated": "2014-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "SD",
            "license": "472",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN/ID",
            "identifier": "S102729",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6552660",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookings, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.