Individual provider Active NPI

Mark A. Bledsoe, D.C.

  • Chiropractor
  • Aberdeen, SD
National Provider Identifier
1790710796
Registry record updated Mar 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
653 Issued in SD
Practice address
221 6TH Ave SE
Suite 1
Aberdeen, SD 57401-4362
Phone
(605) 229-1212
Fax
(605) 229-4440
NPI assigned
Jul 11, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 30, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 653 SD Primary

Addresses

Primary practice location

221 6TH Ave SE
Suite 1
Aberdeen, SD 57401-4362

Mailing address

221 6TH Ave SE
Suite 1
Aberdeen, SD 57401-4362
Phone (605) 229-1212

Other identifiers 1

IdentifierTypeStateIssuer
7600240MedicaidSD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040526000105 SD Practitioner - Chiropractic 6901887199 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Odland Chiropractic Clinic PCGroup PAC ID 7810071438, 3 clinicians
Eureka Chiropractic Clinic Prof LLCGroup PAC ID 4587645767, 2 clinicians

Practice addresses (Care Compare)

3600 S Marion Rd
Sioux Falls, SD 57106-1307
Phone (605) 361-2500

804 G Ave
Eureka, SD 57437-2339
Phone (605) 284-2385

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
659SDMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Odland Chiropractic Clinic PC Chiropractor CurrentSince Jan 1, 2023 Accepting new patients
Eureka Chiropractic Clinic, Prof LLC Chiropractor CurrentSince Jan 1, 2004 Accepting new patients

Locations

3600 S Marion Rd
Ste 101
Sioux Falls, SD 57106
Phone (605) 361-2500

3600 S Marion Rd
Sioux Falls, SD 57106
Phone (605) 361-2500

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333065600000",
    "number": "1790710796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 6TH AVE SE",
            "address_2": "SUITE 1",
            "city": "ABERDEEN",
            "state": "SD",
            "postal_code": "574014362",
            "telephone_number": "605-229-1212",
            "fax_number": "605-229-4440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 6TH AVE SE",
            "address_2": "SUITE 1",
            "city": "ABERDEEN",
            "state": "SD",
            "postal_code": "574014362",
            "telephone_number": "605-229-1212",
            "fax_number": "605-229-4440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLEDSOE",
        "first_name": "MARK",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2012-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "SD",
            "license": "653",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7600240",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Aberdeen, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2012; 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.