NPIMap

Individual provider Active NPI

Timothy D Matthew, CRNA

  • Certified Registered Nurse Anesthetist
  • Rapid City, SD
National Provider Identifier
1912017070
Registry record updated Dec 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
CR000660 Issued in SD
Practice address
353 Fairmont Blvd
Rapid City, SD 57701
Phone
(605) 719-1000
NPI assigned
Aug 30, 2006
Last updated
Dec 28, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X R029305 SD
Certified Registered Nurse Anesthetist 367500000X R49054 ND
Certified Registered Nurse Anesthetist 367500000X CR000660 SD Primary

Addresses

Primary practice location

353 Fairmont Blvd
Rapid City, SD 57701

Mailing address

353 Fairmont Blvd
Atten Medical Staff Services
Rapid City, SD 57701-6000

Other practice location 1

1 Burdick Expy W
Minot, ND 58701-4406
Phone (701) 857-5000

Other practice location 2

2305 37th Ave SW
Minot, ND 58701-7669
Phone (701) 857-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081211000400 SD Practitioner - Certified Registered Nurse Anesthetist (Crna) 6406917244 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

353 Fairmont Blvd
Rapid City, SD 57701-7375
Phone (605) 755-8109

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R49054NDMDCertified Registered Nurse Anesthetist
CR000660SDMDCertified Registered Nurse Anesthetist
R029305SDMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Monument Health Rapid City Hospital, Inc. CurrentSince Aug 28, 2002 Accepting new patients
Monument Health Rapid City Hospital Inc CurrentSince Aug 28, 2002 Accepting new patients
Monument Health Network, Inc. CurrentSince Apr 15, 2016 Accepting new patients
Monument Health Network, Inc. CurrentSince Apr 15, 2016 Accepting new patients
Monument Health Rapid City Hospital, Inc Current Accepting new patients
Monument Health Network, Inc. Current Accepting new patients

Locations

353 Fairmont Blvd
Rapid City, SD 57701
Phone (605) 719-1000

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

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 12

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": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703721600000",
    "number": "1912017070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "353 FAIRMONT BLVD",
            "address_2": "ATTEN MEDICAL STAFF SERVICES",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577016000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "353 FAIRMONT BLVD",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "57701",
            "telephone_number": "605-719-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Burdick Expy W",
            "address_purpose": "LOCATION",
            "city": "Minot",
            "state": "ND",
            "postal_code": "587014406",
            "country_code": "US",
            "telephone_number": "701-857-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2305 37th Ave SW",
            "address_purpose": "LOCATION",
            "city": "Minot",
            "state": "ND",
            "postal_code": "587017669",
            "country_code": "US",
            "telephone_number": "701-857-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATTHEW",
        "first_name": "TIMOTHY",
        "middle_name": "D",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2023-12-28",
        "certification_date": "2023-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "SD",
            "license": "R029305",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ND",
            "license": "R49054",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "SD",
            "license": "CR000660",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rapid City, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.