NPIMap

Individual provider Active NPI

Chester Penn De Jong, M.D.

  • Family Medicine Physician
  • Rock Rapids, IA
National Provider Identifier
1952484909
Registry record updated Dec 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
28191 Issued in IA
Practice address
803 S Greene St
Rock Rapids, IA 51246-1948
Phone
(712) 472-3716
Fax
(712) 472-2878
NPI assigned
Oct 23, 2006
Last updated
Dec 15, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 28191 IA Primary

Addresses

Primary practice location

803 S Greene St
Rock Rapids, IA 51246-1948

Mailing address

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

Other identifiers 4

IdentifierTypeStateIssuer
1075648MedicaidIA
4075648MedicaidIA
0250498MedicaidIA
0638700MedicaidIA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060329000734 IA Practitioner - Family PracticePractitioner - Emergency Medicine 3577571769 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine
Education
Sanford School of Medicine of University of South Dakota, 1989
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)

104 Buncombe Dr
Rock Rapids, IA 51246-1003
Phone (712) 472-3333

118 N 7TH Ave
Sheldon, IA 51201-1235
Phone (605) 328-8900

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

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions12
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
28191IAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center Family Medicine CurrentSince Jul 1, 2022 Accepting new patients
Sanford Clinic Family Medicine Current Accepting new patients
Sanford Clinic CurrentSince May 1, 2019 Accepting new patients
Sanford Clinic Family Medicine CurrentSince May 1, 2019 Accepting new patients
Sanford Clinic Family Medicine Past Accepting new patients

Locations

303 E Jefferson St
Inwood, IA 51240
Phone (712) 753-4401

104 Buncombe Dr
Rock Rapids, IA 51246
Phone (712) 472-3333

118 N 7th Ave
Sheldon, IA 51201
Phone (712) 324-5041

2720 Stone Park Blvd
Sioux City, IA 51104
Phone (712) 259-3000

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Good Samaritan Society - GeorgeGeorge, IA, CCN 165247 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Feb 2, 2018
Feb 2, 2018

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639526400000",
    "number": "1952484909",
    "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",
            "fax_number": "605-328-6512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 S GREENE ST",
            "city": "ROCK RAPIDS",
            "state": "IA",
            "postal_code": "512461948",
            "telephone_number": "712-472-3716",
            "fax_number": "712-472-2878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE JONG",
        "first_name": "CHESTER",
        "middle_name": "PENN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-23",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "28191",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1075648",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4075648",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0250498",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0638700",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rock Rapids, IA

Sources for this page

Verify at the official NPI Registry.