Active NPI
Bowdle Clinic
- Clinic/Center
- Bowdle, SD
National Provider Identifier
1982760435
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- Legal business name
- BOWDLE CLINIC
- Practice address
- 8001 West 5TH Street
Bowdle, SD 57428-0556 - Phone
- (605) 285-6832
- Fax
- (605) 285-6986
- NPI assigned
- Dec 29, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Jon Kosiak
- Title
- Ceo
- Phone
- (605) 285-6146
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Primary |
Addresses
Primary practice location
8001 West 5TH Street
Bowdle, SD 57428-0556
Mailing address
P.O. Box 556
Bowdle, SD 57428-0556
Phone (605) 285-6146
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0030101 | Other | SD | BLUE CROSS |
| 5800500 | Medicaid | SD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SD
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040325001225 | SD | Part B Supplier - Clinic/Group Practice | 9335056902 |
Receives reassigned benefits from 6 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Bowdle, SD |
Other NPIs on the same Medicare enrollment 4
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167350400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1982760435",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 556",
"city": "BOWDLE",
"state": "SD",
"postal_code": "574280556",
"telephone_number": "605-285-6146",
"fax_number": "605-285-6410"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8001 WEST 5TH STREET",
"city": "BOWDLE",
"state": "SD",
"postal_code": "574280556",
"telephone_number": "605-285-6832",
"fax_number": "605-285-6986"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BOWDLE CLINIC",
"organizational_subpart": "NO",
"enumeration_date": "2006-12-29",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "KOSIAK",
"authorized_official_first_name": "JON",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "605-285-6146",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "0030101",
"state": "SD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5800500",
"state": "SD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bowdle, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.