Individual provider Active NPI

Marissa Soukup, PA-C

  • Physician Assistant
  • Sioux Falls, SD
National Provider Identifier
1922479997
Registry record updated Jun 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1000 Issued in SD
Practice address
4405 E 26TH St
Sioux Falls, SD 57103-4187
Phone
(605) 328-9000
NPI assigned
Oct 15, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1000 SD Primary

Addresses

Primary practice location

4405 E 26TH St
Sioux Falls, SD 57103-4187

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mmeyer5217651@direct.sanfordhealth.org

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
I20151222001050 SD Practitioner - Physician Assistant 1153622899 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
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)

1309 W 17TH St
Suite G01
Sioux Falls, SD 57104-4664
Phone (605) 312-3400

4405 E 26TH St
Sioux Falls, SD 57103-4187
Phone (605) 332-2883

Hospital & facility affiliations

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
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Clinic CurrentSince Nov 14, 2015 Accepting new patients
Sanford Medical Center Physician Assistant CurrentSince Nov 14, 2015 Accepting new patients
Sanford Medical Center CurrentSince Nov 14, 2015 Accepting new patients
Sanford Clinic CurrentSince Nov 14, 2015 Accepting new patients
Sanford Clinic Past Accepting new patients

Locations

525 N Foster St
Mitchell, SD 57301
Phone (605) 995-2000

1309 W 17th St
Ste G01
Sioux Falls, SD 57104
Phone (605) 312-3400

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

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

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 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": "1444867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718323200000",
    "number": "1922479997",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4405 E 26TH ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571034187",
            "telephone_number": "605-328-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUKUP",
        "first_name": "MARISSA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-15",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SD",
            "license": "1000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmeyer5217651@direct.sanfordhealth.org",
            "affiliation": "N",
            "address_1": "4405 E 26th St",
            "city": "Sioux Falls",
            "state": "SD",
            "country_code": "US",
            "postal_code": "571034187",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.