NPIMap

Individual provider Active NPI

Kelly J Wasko, CNP

  • Nurse Practitioner
  • Sioux Falls, SD
National Provider Identifier
1841252541
Registry record updated Aug 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
CP000463 Issued in SD
Practice address
4520 W 69TH St
Sioux Falls, SD 57108-8148
Phone
(605) 977-5000
Fax
(605) 977-5377
NPI assigned
Apr 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2012

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 CP000463 SD Primary

Addresses

Primary practice location

4520 W 69TH St
Sioux Falls, SD 57108-8148

Mailing address

4520 W 69TH St
Sioux Falls, SD 57108-8148
Phone (605) 977-5000

Other identifiers 7

IdentifierTypeStateIssuer
6828360MedicaidSD
01-23603OtherMEDICA SELECTCARE
60832OtherHEALTH PARTNER
975839900MedicaidMN
931451047306OtherPREFERRED ONE
182837OtherUCARE
4994141OtherSDSD BCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060309000636 SD Practitioner - Nurse Practitioner 9436166865 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera McKennanGroup PAC ID 0345157103, 957 clinicians
Heart Hospital of South Dakota LLCGroup PAC ID 5799777249, shared by 2 NPIs, 66 clinicians

Practice addresses (Care Compare)

1200 S 7TH Ave
Sioux Falls, SD 57105-0900
Phone (605) 336-2140

1600 S Highline Ave
Sioux Falls, SD 57110-1008

1910 W 69TH St
Sioux Falls, SD 57108-5612
Phone (605) 322-5200

2100 S Marion Rd
Sioux Falls, SD 57106-3646
Phone (605) 322-5180

4500 W 69TH St
Sioux Falls, SD 57108-8148
Phone (605) 977-7000

4520 W 69TH St
Sioux Falls, SD 57108-8148
Phone (605) 977-5000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
CP000463SDMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince Jul 25, 2008 Accepting new patients
Heart Hospital of South Dakota LLC CurrentSince Dec 23, 2012 Accepting new patients
Avera McKennan Current Accepting new patients
Avera McKennan CurrentSince Jul 25, 2008 Accepting new patients
Heart Hospital of South Dakota LLC CurrentSince Dec 23, 2012 Accepting new patients
Avera McKennan Nurse Practitioner Past Accepting new patients

Locations

3000 S Minnesota Ave
Sioux Falls, SD 57105
Phone (605) 332-1502

1200 S 7th Ave
Sioux Falls, SD 57105
Phone (605) 336-2140

4500 W 69th St
Sioux Falls, SD 57108
Phone (605) 977-7000

1910 W 69th St
Sioux Falls, SD 57108
Phone (605) 322-5200

4520 W 69th St
Sioux Falls, SD 57108
Phone (605) 977-5000

Interoperability endpoints

  • Direct secure messaging: kelly.wasko@avera.sdhealthlink.net

Organizations & group practices 6

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.

Hospital & facility affiliations 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344988800000",
    "number": "1841252541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4520 W 69TH ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571088148",
            "telephone_number": "605-977-5000",
            "fax_number": "605-977-5377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4520 W 69TH ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571088148",
            "telephone_number": "605-977-5000",
            "fax_number": "605-977-5377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASKO",
        "first_name": "KELLY",
        "middle_name": "J",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-06",
        "last_updated": "2012-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SD",
            "license": "CP000463",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6828360",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA SELECTCARE",
            "identifier": "01-23603",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNER",
            "identifier": "60832",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "975839900",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "931451047306",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "182837",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SD BCBS",
            "identifier": "4994141",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.