NPIMap

Individual provider Active NPI

Larissa Bennis, MD

  • Obstetrics & Gynecology Physician
  • Brookings, SD
National Provider Identifier
1851612337
Registry record updated Jun 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
9140 Issued in SD
Practice address
310 22ND Ave
Brookings, SD 57006-2474
Phone
(605) 696-2700
NPI assigned
Jun 18, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 9140 SD Primary

Addresses

Primary practice location

310 22ND Ave
Brookings, SD 57006-2474

Mailing address

310 22ND Ave
Brookings, SD 57006-2474
Phone (605) 696-2700

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
I20141103002456 SD Practitioner - Obstetrics/Gynecology 6709032170 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Sanford School of Medicine of University of South Dakota, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
City of Brookings 112 clinicians

Practice addresses (Care Compare)

400 22ND Ave
Brookings, SD 57006-2447
Phone (605) 697-9500

Hospital & facility affiliations

  • Brookings Health System Hospital, Brookings, SD, CCN 430008

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
City of Brookings CurrentSince Sep 1, 2014 Accepting new patients
City of Brookings CurrentSince Sep 1, 2014 Accepting new patients
City of Brookings Current Accepting new patients
City of Brookings Past Accepting new patients
Avera McKennan Past Accepting new patients

Locations

310 22nd Ave
Brookings, SD 57006
Phone (605) 696-2700

400 22nd Ave
Brookings, SD 57006
Phone (605) 692-6236

300 22nd Ave
Brookings, SD 57006
Phone (605) 692-6351

Interoperability endpoints

  • Direct secure messaging: larissa.bennis@avera.sdhealthlink.net

Organizations & group practices 11

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 4

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

NPI Registry JSON

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

{
    "created_epoch": "1276819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561593600000",
    "number": "1851612337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 22ND AVE",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "570062474",
            "telephone_number": "605-696-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 22ND AVE",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "570062474",
            "telephone_number": "605-696-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNIS",
        "first_name": "LARISSA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-18",
        "last_updated": "2019-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "SD",
            "license": "9140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookings, SD

Sources for this page

Verify at the official NPI Registry.