Individual provider Active NPI

Jay Matthew Eidsness, P.T.

  • Physical Therapist
  • Sioux Falls, SD
National Provider Identifier
1821246240
Registry record updated Aug 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
0913 Issued in SD
Practice address
810 E 23Rd St
2ND Floor
Sioux Falls, SD 57105-2135
Phone
(605) 322-5123
NPI assigned
Aug 28, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 0913 SD Primary

Addresses

Primary practice location

810 E 23Rd St
2ND Floor
Sioux Falls, SD 57105-2135

Mailing address

810 E 23Rd St
2ND Floor
Sioux Falls, SD 57105-2135
Phone (605) 322-5123

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141111002421 SD Practitioner - Physical Therapist in Private Practice 9638391444 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera McKennanGroup PAC ID 0345157103, 957 clinicians

Practice addresses (Care Compare)

300 W 5TH St
Miller, SD 57362-1238
Phone (605) 853-0158

6800 S Louise Ave
Sioux Falls, SD 57108-6026
Phone (605) 504-1100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince Apr 1, 2014 Accepting new patients
Avera McKennan CurrentSince Apr 1, 2014 Accepting new patients
Avera McKennan Past Accepting new patients

Locations

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

810 E 23rd St
Fl 2
Sioux Falls, SD 57105
Phone (605) 322-5123

6800 S Louise Ave
Sioux Falls, SD 57108
Phone (605) 322-3278

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": "1219881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219881600000",
    "number": "1821246240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 E 23RD ST",
            "address_2": "2ND FLOOR",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571052135",
            "telephone_number": "605-322-5123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 E 23RD ST",
            "address_2": "2ND FLOOR",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571052135",
            "telephone_number": "605-322-5123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EIDSNESS",
        "first_name": "JAY",
        "middle_name": "MATTHEW",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-28",
        "last_updated": "2008-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SD",
            "license": "0913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2008; 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.