Active NPI
Alexandra Kathryn Mimmack, PA-C
- Physician Assistant
- Sioux Falls, SD
National Provider Identifier
1861074411
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1296
- Practice address
- 4201 S Minnesota Ave
Sioux Falls, SD 57105-6705 - Phone
- (605) 335-3349
- NPI assigned
- Apr 23, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1296 | SD | Primary |
Addresses
Primary practice location
4201 S Minnesota Ave
Sioux Falls, SD 57105-6705
Mailing address
4017 S Catcher CT
Sioux Falls, SD 57110-6868
Phone (605) 321-0552
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
4201 S Minnesota Ave
Sioux Falls, SD 57105-6706
Phone (605) 335-3349
Hospital & facility affiliations
- Sioux Falls Specialty Hospital
- Avera McKennan Hospital & University Health Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Upper Midwest Medical Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Plastic Surgery Physician
- Sioux Falls, SD
- NPI 1457389199
-
- Surgery Physician
- Sioux Falls, SD
- NPI 1235796533
Hospital & facility affiliations 24
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Sioux Falls, SD
- NPI 1154531630
-
- General Acute Care Hospital
- Sioux Falls, SD
- NPI 1184834764
-
- Endocrinology, Diabetes & Metabolism Physician
- Sioux Falls, SD
- NPI 1396711016
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1619136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711065600000",
"number": "1861074411",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4017 S CATCHER CT",
"city": "SIOUX FALLS",
"state": "SD",
"postal_code": "571106868",
"telephone_number": "605-321-0552"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4201 S MINNESOTA AVE",
"city": "SIOUX FALLS",
"state": "SD",
"postal_code": "571056705",
"telephone_number": "605-335-3349"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIMMACK",
"first_name": "ALEXANDRA",
"middle_name": "KATHRYN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-23",
"last_updated": "2024-03-22",
"certification_date": "2024-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "SD",
"license": "1296",
"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 Mar 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.