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Individual provider Active NPI

Theresa Ann Mehrman, CNP

  • Nurse Practitioner
  • Sioux Falls, SD
National Provider Identifier
1790018935
Registry record updated May 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
CP000564 Issued in SD
Practice address
3720 W 69TH St
Sioux Falls, SD 57108-8192
Phone
(605) 322-5290
Fax
(605) 322-5252
NPI assigned
Sep 4, 2009
Last updated
May 15, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2014

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 CP000564 SD Primary

Addresses

Primary practice location

3720 W 69TH St
Sioux Falls, SD 57108-8192

Mailing address

3720 W 69TH St
Sioux Falls, SD 57108-8192
Phone (605) 322-5290

Other identifiers 9

IdentifierTypeStateIssuer
460484580OtherGROUP TAX ID
6828312MedicaidSD
1790018935OtherMNBCBS OF MN
1790018935MedicaidSD
1790018935MedicaidIA
460484580OtherSDWELLMARK OF SD AND IA
1790018935OtherSDDAKOTACARE
6832603MedicaidSD
1235196056OtherGROUP NPI

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
I20091016000416 SD Practitioner - Nurse Practitioner 9234276668 Reassigns benefits to 1 organization
I20110315001021 MN Practitioner - Nurse Practitioner 9234276668 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Avera McKennanGroup PAC ID 0345157103, 957 clinicians

Practice addresses (Care Compare)

1000 E 23Rd St
Sioux Falls, SD 57105-2122

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
CP000564SDMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Avera Marshall CurrentSince Nov 4, 2019 Accepting new patients
Avera Marshall Current Accepting new patients
Avera McKennan Current Accepting new patients
Avera Marshall CurrentSince Nov 4, 2019 Accepting new patients
Avera McKennan Nurse Practitioner Past Accepting new patients

Locations

300 S Bruce St
Marshall, MN 56258
Phone (507) 532-9631

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 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1252022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400112000000",
    "number": "1790018935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3720 W 69TH ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571088192",
            "telephone_number": "605-322-5290",
            "fax_number": "605-322-5252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3720 W 69TH ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571088192",
            "telephone_number": "605-322-5290",
            "fax_number": "605-322-5252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEHRMAN",
        "first_name": "THERESA",
        "middle_name": "ANN",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-04",
        "last_updated": "2014-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SD",
            "license": "CP000564",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP TAX ID",
            "identifier": "460484580",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6828312",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN",
            "identifier": "1790018935",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1790018935",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1790018935",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK OF SD AND IA",
            "identifier": "460484580",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAKOTACARE",
            "identifier": "1790018935",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6832603",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1235196056",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.