Joan E Gibson, MD
Individual provider Active NPI Pediatrics Physician · Pine Ridge, SD
NPI 1962474965 · NPPES record last updated Mar 26, 2014
Key facts
- NPI
- 1962474965
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 5548 (SD)
- Practice address
- 1 Highway 18
Pine Ridge, SD 57770-9998 - Phone
- (605) 867-5131
- Fax
- (605) 867-3306
- NPI assigned
- Feb 3, 2006
- Reactivated
- Jan 18, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080425000497 | TX | Practitioner - Pediatric Medicine | 0840229969 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33818 | AZ | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Great Plains Tribal Chairmen'S Health Board | Current |
Accepting new patients | |
| Regional Health Physicians Inc | Past | Accepting new patients | |
| Rosebud Indian Health Service | Past | Accepting new patients |
Locations
3200 Canyon Lake Dr
Rapid City, SD 57702
Phone (605) 355-2282
3200 Canyon Lake Dr
Ste 1
Rapid City, SD 57702
Phone (605) 355-2500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 5548 | SD | Yes |
| Pediatrics Physician | 208000000X | 33818 | AZ | |
| Pediatrics Physician | 208000000X | 217566 | NY |
Addresses
Primary practice location
1 Highway 18
Pine Ridge, SD 57770-9998
Mailing address
PO Box 1201
Highway 18 East
Pine Ridge, SD 57770-1201
Phone (605) 867-5131
Other providers in Pine Ridge, SD
- Krista Sue Evans
- Fort Meade Vamc
- Arrow Garnier
- Vonda Lee Gates
- James Brian Gibbon
- Elaine Gilfillan
- Nicole Joy Glines
- Paul Douglas Hall
- Johanna Christine Hewitt
- Virginia Horn
All providers in Pine Ridge, SD · Pediatrics Physician in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 26, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.