Edgewood Rapid City LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

EDGEWOOD RAPID CITY LLC

Practice address

4001 Derby Lane
Rapid City, SD 57701

Phone

(605) 718-3600

Fax

(701) 738-2001

NPI assigned

Jan 10, 2019

Last updated

Jan 14, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

John Dybwad

Title

Vice President of Finance

Phone

(701) 757-5422

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1547078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547424000000",
    "number": "1972076024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 DEMERS AVE STE 500",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "58201",
            "telephone_number": "701-757-5410",
            "fax_number": "701-738-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 DERBY LANE",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "57701",
            "telephone_number": "605-718-3600",
            "fax_number": "701-738-2001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWOOD RAPID CITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-10",
        "last_updated": "2019-01-14",
        "status": "A",
        "authorized_official_last_name": "DYBWAD",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "VICE PRESIDENT OF FINANCE",
        "authorized_official_telephone_number": "701-757-5422"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eccarius Eye Clinic, PC
• Scott Eccarius, MD
• Stephen G.J. Eckrich, MD
• Rachel C Edelen, MD
• Kayla Nichole Ederveen
• Edward J. Lynch, DDS, PC
• Brianne Edwards
• David P Edwards, CRNA
• Holly Edwards
• Randall Lee Edwards, O.D.

• Assisted Living Facility in Rapid City, SD
• Providers in Rapid City, SD by specialty
• Assisted Living Facility in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.