Ryan Baxter, DMD
Individual provider Active NPI Dentist · Pine Ridge, SD
NPI 1962853564 · NPPES record last updated Jun 4, 2024
Key facts
- NPI
- 1962853564
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D1410 (SD)
- Practice address
- 607 Indian Health Rd
Pine Ridge, SD 57770-3169 - Phone
- (605) 867-5131
- NPI assigned
- Jun 24, 2016
- Sex
- Male
- 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: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200804001935 | TX | Practitioner - Dentist | 1850686338 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00204006 | CO | MD | Dentist |
| D1410 | SD | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pine Ridge Indian Health Service Hospital | Current |
Accepting new patients | |
| Pine Ridge Indian Health Service Hospital | Past |
Accepting new patients | |
| Pine Ridge Indian Health Service Hospital | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 00204006 | CO | |
| Dentist | 122300000X | DD5145 | NM | |
| Dentist | 122300000X | D1410 | SD | Yes |
Addresses
Primary practice location
607 Indian Health Rd
Pine Ridge, SD 57770-3169
Mailing address
2004 Noah Street
Rapid City, SD 57703
Phone (605) 381-7284
Other providers in Pine Ridge, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 4, 2024. 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.