Active NPI
Mason Wellskopf
- Registered Dietitian
- Spearfish, SD
National Provider Identifier
1962004523
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 0742
- Practice address
- 1420 N 10TH St
Spearfish, SD 57783-1532 - Phone
- (605) 717-8595
- NPI assigned
- Nov 9, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 0742 | SD | Primary |
Addresses
Primary practice location
1420 N 10TH St
Spearfish, SD 57783-1532
Mailing address
918 Saint Joe St
Spearfish, SD 57783-1729
Phone (715) 450-5025
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0742 | SD | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604880000000",
"number": "1962004523",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "918 SAINT JOE ST",
"city": "SPEARFISH",
"state": "SD",
"postal_code": "577831729",
"telephone_number": "715-450-5025"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1420 N 10TH ST",
"city": "SPEARFISH",
"state": "SD",
"postal_code": "577831532",
"telephone_number": "605-717-8595"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WELLSKOPF",
"first_name": "MASON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-11-09",
"last_updated": "2020-11-09",
"certification_date": "2020-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "SD",
"license": "0742",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spearfish, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.