NPIMap

Individual provider Active NPI

Courtney L Hubert, PA-C

  • Physician Assistant
  • Sioux Falls, SD
National Provider Identifier
1851862544
Registry record updated Oct 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1243 Issued in SD
Practice address
1500 W 22ND St Ste 301
Sioux Falls, SD 57105-1503
Phone
(605) 328-7700
Fax
(605) 328-7775
NPI assigned
Dec 6, 2018
Last updated
Oct 1, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 1, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1243 SD Primary
Medical Physician Assistant 363AM0700X 5601008846 MI

Addresses

Primary practice location

1500 W 22ND St Ste 301
Sioux Falls, SD 57105-1503

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074

Other practice location 1

6565 W Main St Ste 100
Kalamazoo, MI 49009-9144
Phone (269) 375-0400

Other identifiers 2

IdentifierTypeStateIssuer
1243OtherSDPHYSICIAN ASSISTANT LICENSE
5601008846OtherMIPHYSICIAN'S ASSISTANT LICENSE

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
I20210409001704 SD Practitioner - Physician Assistant 7618216573 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford Medical CenterGroup PAC ID 8325950215, 847 clinicians

Practice addresses (Care Compare)

4405 E 26TH St
Sioux Falls, SD 57103-4187
Phone (605) 332-2883

5019 S Western Ave
Suite 200
Sioux Falls, SD 57108-5155
Phone (605) 328-9700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.32 of 100Reported as group
Quality
75.87
Promoting interoperability
100
Improvement activities
40
Cost
68.53

Merit-based Incentive Payment System (MIPS)

Final score
84.78 of 100Reported as group
Quality
78.77
Promoting interoperability
100
Improvement activities
40
Cost
70.49

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1243SDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Clinic CurrentSince Dec 31, 2020 Accepting new patients
Sanford Medical Center Physician Assistant CurrentSince Dec 31, 2020 Accepting new patients
Sanford Clinic CurrentSince Dec 31, 2020 Accepting new patients
Sanford Medical Center CurrentSince Dec 31, 2020 Accepting new patients
Sanford Clinic Past Accepting new patients

Locations

1305 W 18th St
Sioux Falls, SD 57105
Phone (605) 312-7300

1500 W 22nd St
Ste 102
Sioux Falls, SD 57105
Phone (605) 328-8800

1500 W 22nd St
Ste 301
Sioux Falls, SD 57105
Phone (605) 328-7700

4405 E 26th St
Sioux Falls, SD 57103
Phone (605) 328-9000

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1544054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601510400000",
    "number": "1851862544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 W 22ND ST STE 301",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051503",
            "telephone_number": "605-328-7700",
            "fax_number": "605-328-7775"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6565 W Main St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Kalamazoo",
            "state": "MI",
            "postal_code": "490099144",
            "country_code": "US",
            "telephone_number": "269-375-0400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HUBERT",
        "first_name": "COURTNEY",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-12-06",
        "last_updated": "2020-10-01",
        "certification_date": "2020-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SD",
            "license": "1243",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601008846",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN ASSISTANT LICENSE",
            "identifier": "1243",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN'S ASSISTANT LICENSE",
            "identifier": "5601008846",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.