NPIMap

Individual provider Active NPI

Ryan Daniel Prusa, DPM

  • Foot & Ankle Surgery Podiatrist
  • Brookings, SD
National Provider Identifier
1902464027
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
249 Issued in SD
Practice address
400 22ND Ave
Brookings, SD 57006-2447
Phone
(605) 697-9500
NPI assigned
Jun 4, 2019
Last updated
Aug 13, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 096109 IA
Foot & Ankle Surgery Podiatrist 213ES0103X 249 SD Primary

Addresses

Primary practice location

400 22ND Ave
Brookings, SD 57006-2447

Mailing address

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD, MN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220909001913 SD Practitioner - Podiatry 8729312871 Reassigns benefits to 1 organization
I20230224001959 MN Practitioner - Podiatry 8729312871 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
City of BrookingsGroup PAC ID 1052307105, 112 clinicians
Avera McKennanGroup PAC ID 0345157103, 957 clinicians

Practice addresses (Care Compare)

212 N Prairie St
Flandreau, SD 57028-1243
Phone (605) 997-2471

214 N Prairie St
Flandreau, SD 57028-1243
Phone (605) 997-2433

300 22ND Ave
Brookings, SD 57006-2480
Phone (605) 692-6351

300 22ND Ave
Brookings, SD 57006-2496

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

310 22ND Ave
Brookings, SD 57006-2474
Phone (605) 697-9500

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

501 E Lincoln St
Hendricks, MN 56136-9598
Phone (507) 275-3121

503 E Lincoln St
Hendricks, MN 56136-9598
Phone (507) 275-3134

911 5TH Ave SW
Pipestone, MN 56164-1054
Phone (507) 825-5811

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue28
Removal of skin lesions1-10
Removal of nail tissue262
Removal or shaving of skin growth129

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
096109IAMDPodiatrist
249SDMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince Jan 10, 2023 Accepting new patients
Avera McKennan CurrentSince Jan 10, 2023 Accepting new patients
City of Brookings Current Accepting new patients
City of Brookings CurrentSince Sep 1, 2022 Accepting new patients
City of Brookings Current Accepting new patients
City of Brookings CurrentSince Sep 1, 2022 Accepting new patients
Avera McKennan Past Accepting new patients

Locations

911 5th Ave SW
Pipestone, MN 56164
Phone (507) 825-5811

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

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

Interoperability endpoints

  • Direct secure messaging: ryan.prusa@avera.sdhealthlink.net

Organizations & group practices 7

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 30

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

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1559606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1902464027",
    "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": "570062447",
            "telephone_number": "605-697-9500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 22ND AVE",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "570062447",
            "telephone_number": "605-697-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUSA",
        "first_name": "RYAN",
        "middle_name": "DANIEL",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-06-04",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IA",
            "license": "096109",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "SD",
            "license": "249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookings, SD

Sources for this page

Verify at the official NPI Registry.