Individual provider Active NPI

Katie Marie Moen, FNP-C

  • Nurse Practitioner
  • Sioux Falls, SD
National Provider Identifier
1912676149
Registry record updated May 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
CP002201 Issued in SD
Practice address
6110 S Minnesota Ave
Sioux Falls, SD 57108-2549
Phone
(605) 332-2883
NPI assigned
Sep 10, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Registered Nurse 163WE0003X R047682 SD
Nurse Practitioner 363L00000X CP002201 SD Primary

Addresses

Primary practice location

6110 S Minnesota Ave
Sioux Falls, SD 57108-2549

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074
Phone (605) 328-6585

Other practice location 1

2100 S Marion Rd
Sioux Falls, SD 57106-3646
Phone (605) 322-1730

Other practice location 2

1305 W 18th St
Sioux Falls, SD 57105-0401
Phone (605) 333-1000

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220628003535 SD Practitioner - Nurse Practitioner 0941680532 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
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

6110 S Minnesota Ave
Sioux Falls, SD 57108-2549
Phone (605) 328-5800

Hospital & facility affiliations

  • Sanford Usd Medical Center Hospital, Sioux Falls, SD, CCN 430027

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
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R047682SDMDEmergency Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center Nurse Practitioner CurrentSince Mar 19, 2022 Accepting new patients

Locations

1105 E Holly Blvd
Brandon, SD 57005
Phone (605) 582-5820

2601 S Ellis Rd
Sioux Falls, SD 57106
Phone (605) 312-3000

6110 S Minnesota Ave
Sioux Falls, SD 57108
Phone (605) 328-5800

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

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

Organizations & group practices 1

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 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": "1631232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653523200000",
    "number": "1912676149",
    "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",
            "telephone_number": "605-328-6585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6110 S MINNESOTA AVE",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571082549",
            "telephone_number": "605-332-2883"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2100 S Marion Rd",
            "address_purpose": "LOCATION",
            "city": "Sioux Falls",
            "state": "SD",
            "postal_code": "571063646",
            "country_code": "US",
            "telephone_number": "605-322-1730",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1305 W 18th St",
            "address_purpose": "LOCATION",
            "city": "Sioux Falls",
            "state": "SD",
            "postal_code": "571050401",
            "country_code": "US",
            "telephone_number": "605-333-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOEN",
        "first_name": "KATIE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-10",
        "last_updated": "2022-05-26",
        "certification_date": "2022-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "SD",
            "license": "R047682",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SD",
            "license": "CP002201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.