NPIMap

Individual provider Active NPI

Heather D Dougherty, CRNA

  • Certified Registered Nurse Anesthetist
  • Sioux Falls, SD
National Provider Identifier
1912913823
Registry record updated Mar 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R030566 Issued in SD
Practice address
800 E 21St St
Sioux Falls, SD 57105-1016
Phone
(605) 322-2754
Fax
(605) 322-2727
NPI assigned
Jul 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X R030566 SD Primary

Addresses

Primary practice location

800 E 21St St
Sioux Falls, SD 57105-1016

Mailing address

800 E 21St St
Sioux Falls, SD 57105-1016
Phone (605) 322-2754

Other identifiers 6

IdentifierTypeStateIssuer
5754760MedicaidSD
175P1DOOtherMNMN BC PROVIDER #
4994627OtherSDSD BC PROVIDER #
R030566OtherSDDAKOTACARE
0715896MedicaidIA
46022474348MedicaidNE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050317000111 SD Practitioner - Certified Registered Nurse Anesthetist (Crna) 2365497807 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera McKennanGroup PAC ID 0345157103, 957 clinicians

Practice addresses (Care Compare)

1325 S Cliff Ave
Sioux Falls, SD 57105-1007

909 N Iowa Ave
Dell Rapids, SD 57022-1231
Phone (605) 428-5431

Hospital & facility affiliations

  • Avera McKennan Hospital & University Health Center Hospital, Sioux Falls, SD, CCN 430016

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince Oct 27, 2004 Accepting new patients
Avera McKennan Nurse Anesthetist, Certified Registered CurrentSince Oct 27, 2004 Accepting new patients
Avera McKennan Current Accepting new patients

Locations

909 N Iowa Ave
Dell Rapids, SD 57022
Phone (605) 428-5431

800 E 21st St
Sioux Falls, SD 57105
Phone (605) 322-2754

Organizations & group practices 3

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": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204761600000",
    "number": "1912913823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 E 21ST ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051016",
            "telephone_number": "605-322-2754",
            "fax_number": "605-322-2727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E 21ST ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051016",
            "telephone_number": "605-322-2754",
            "fax_number": "605-322-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGHERTY",
        "first_name": "HEATHER",
        "middle_name": "D",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-31",
        "last_updated": "2008-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "SD",
            "license": "R030566",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5754760",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN BC PROVIDER #",
            "identifier": "175P1DO",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SD BC PROVIDER #",
            "identifier": "4994627",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAKOTACARE",
            "identifier": "R030566",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0715896",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "46022474348",
            "state": "NE"
        }
    ],
    "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 6, 2008; 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.