NPIMap

Individual provider Active NPI

Jennifer Anderson

  • Family Nurse Practitioner
  • Brookings, SD
National Provider Identifier
1851797948
Registry record updated May 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
CP000909 Issued in SD
Practice address
400 22ND Ave
Brookings, SD 57006-2450
Phone
(605) 697-9500
Fax
(605) 697-6939
NPI assigned
Nov 17, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X CP000909 SD Primary

Addresses

Primary practice location

400 22ND Ave
Brookings, SD 57006-2450

Mailing address

400 22ND Ave
Brookings, SD 57006-2450
Phone (605) 697-9500

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
I20150205001775 SD Practitioner - Nurse Practitioner 4284858150 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera Queen of PeaceGroup PAC ID 9335050806, shared by 12 NPIs, 122 clinicians

Practice addresses (Care Compare)

306 Prairie Ave SW
Avera de Smet Mem HS
De Smet, SD 57231-2285
Phone (605) 854-3329

525 N Foster St
Mitchell, SD 57301-2966
Phone (605) 995-2234

801 3Rd St SW
De Smet, SD 57231-2224
Phone (605) 995-6337

Hospital & facility affiliations

  • Avera @ Home Home health agency, Mitchell, SD, CCN 437041
  • Avera de Smet Memorial Hospital - Cah Hospital, De Smet, SD, CCN 431332
  • Brookings Health System Hospital, Brookings, SD, CCN 430008
  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006
  • St Luke'S Nampa Medical Center Hospital, Nampa, ID, CCN 130071

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
City of Brookings CurrentSince May 1, 2015 Accepting new patients
Avera Queen of Peace CurrentSince Nov 19, 2014 Accepting new patients
Avera Queen of Peace Current Accepting new patients
Avera Queen of Peace Current Accepting new patients
Avera Queen of Peace CurrentSince Nov 19, 2014 Accepting new patients
City of Brookings CurrentSince May 1, 2015 Accepting new patients
City of Brookings Current Accepting new patients
Avera Queen of Peace Past Accepting new patients

Locations

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

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

801 3rd St SW
De Smet, SD 57231
Phone (605) 854-3455

525 N Foster St
Mitchell, SD 57301
Phone (605) 995-2000

Interoperability endpoints

  • Direct secure messaging: jennifer.anderson@avera.sdhealthlink.net

Organizations & group practices 8

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 9

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": "1416182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462752000000",
    "number": "1851797948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 22ND AVE",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "570062450",
            "telephone_number": "605-697-9500",
            "fax_number": "605-697-6939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 22ND AVE",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "570062450",
            "telephone_number": "605-697-9500",
            "fax_number": "605-697-6939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "JENNIFER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-17",
        "last_updated": "2016-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SD",
            "license": "CP000909",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookings, SD

Sources for this page

Verify at the official NPI Registry.