NPIMap

Individual provider Active NPI

Andrea Pedersen

  • Family Nurse Practitioner
  • Sturgis, SD
National Provider Identifier
1891239513
Registry record updated Dec 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
CP001173 Issued in SD
Practice address
890 Lazelle St
Sturgis, SD 57785-1611
Phone
(605) 720-2400
NPI assigned
Dec 14, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 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 CP001173 SD Primary

Addresses

Primary practice location

890 Lazelle St
Sturgis, SD 57785-1611

Mailing address

PO Box 401
Spearfish, SD 57783-0401
Phone (605) 641-6781

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
I20170227001391 SD Practitioner - Nurse Practitioner 6901180595 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Monument Health Network IncGroup PAC ID 5991616427, 163 clinicians

Practice addresses (Care Compare)

2200 13TH Ave
Belle Fourche, SD 57717-2215
Phone (605) 723-8970

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.78 of 100Reported as apm
Quality
80.38
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Monument Health Network, Inc. CurrentSince Jan 21, 2017 Accepting new patients
Monument Health Network, Inc. Current Accepting new patients
Monument Health Network, Inc. CurrentSince Jan 21, 2017 Accepting new patients
Queen City Regional Medical Clinic Past Accepting new patients

Locations

2200 13th Ave
Belle Fourche, SD 57717
Phone (605) 723-8970

1440 N Main St
Spearfish, SD 57783
Phone (605) 644-4000

1420 N 10th St
Spearfish, SD 57783
Phone (605) 642-8414

1445 North Ave
Spearfish, SD 57783
Phone (605) 347-2536

890 Lazelle St
Sturgis, SD 57785
Phone (605) 347-3616

2140 Junction Ave
Sturgis, SD 57785
Phone (605) 720-2400

Organizations & group practices 4

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 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1481673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481673600000",
    "number": "1891239513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 401",
            "city": "SPEARFISH",
            "state": "SD",
            "postal_code": "577830401",
            "telephone_number": "605-641-6781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "890 LAZELLE ST",
            "city": "STURGIS",
            "state": "SD",
            "postal_code": "577851611",
            "telephone_number": "605-720-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSEN",
        "first_name": "ANDREA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-14",
        "last_updated": "2016-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SD",
            "license": "CP001173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sturgis, SD

Sources for this page

Verify at the official NPI Registry.