Individual provider Active NPI

Danielle Elizabeth Etzkorn

  • Nurse Practitioner
  • Pierre, SD
National Provider Identifier
1982284410
Registry record updated Apr 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
CP001996 Issued in SD
Practice address
100 Mac LN
Pierre, SD 57501-3391
Phone
(605) 224-5901
NPI assigned
Apr 9, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X CP001996 SD Primary

Addresses

Primary practice location

100 Mac LN
Pierre, SD 57501-3391

Mailing address

30605 206TH St
Pierre, SD 57501-5903
Phone (605) 280-3252

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210520003136 SD Practitioner - Nurse Practitioner 4183023351 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera St MarysGroup PAC ID 0143134965, 97 clinicians

Practice addresses (Care Compare)

801 E Sioux Ave
Pierre, SD 57501-3323
Phone (605) 224-5901

Hospital & facility affiliations

  • Avera @ Home Home health agency, Pierre, SD, CCN 437046
  • Avera St Mary'S Hospital Hospital, Pierre, SD, CCN 430015

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
CP001996SDMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince Sep 5, 2021 Accepting new patients
Avera McKennan Current Accepting new patients
Avera St Marys CurrentSince May 1, 2021 Accepting new patients
Avera St Marys CurrentSince May 1, 2021 Accepting new patients
Avera McKennan CurrentSince Sep 5, 2021 Accepting new patients
Avera McKennan Past Accepting new patients

Locations

300 W 5th St
Miller, SD 57362
Phone (605) 853-0158

100 Mac Ln
Pierre, SD 57501
Phone (605) 224-5901

Interoperability endpoints

  • Direct secure messaging: danielle.etzkorn@avera.sdhealthlink.net

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1617926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617926400000",
    "number": "1982284410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30605 206TH ST",
            "city": "PIERRE",
            "state": "SD",
            "postal_code": "575015903",
            "telephone_number": "605-280-3252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MAC LN",
            "city": "PIERRE",
            "state": "SD",
            "postal_code": "575013391",
            "telephone_number": "605-224-5901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETZKORN",
        "first_name": "DANIELLE",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-09",
        "last_updated": "2021-04-09",
        "certification_date": "2021-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SD",
            "license": "CP001996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pierre, SD

Sources for this page

Verify at the official NPI Registry.