NPIMap

Individual provider Active NPI

Derek J Sitter, PAC

  • Physician Assistant
  • Sioux Falls, SD
National Provider Identifier
1982875803
Registry record updated Oct 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0674 Issued in SD
Practice address
1325 S. Cliff Ave.
Sioux Falls, SD 57105-1007
Phone
(605) 322-4878
Fax
(605) 322-4820
NPI assigned
Mar 19, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0674 SD Primary

Addresses

Primary practice location

1325 S. Cliff Ave.
Sioux Falls, SD 57105-1007

Mailing address

PO Box 86370
Sioux Falls, SD 57118-6370
Phone (605) 322-7510

Other identifiers 1

IdentifierTypeStateIssuer
6830782MedicaidSD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080731000607 SD Practitioner - Physician Assistant 3678647153 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera McKennanGroup PAC ID 0345157103, 957 clinicians

Practice addresses (Care Compare)

1325 S Cliff Ave
Sioux Falls, SD 57105-1007

300 22ND Ave
Brookings, SD 57006-2480
Phone (605) 504-1600

901 E Virgil Ave
Milbank, SD 57252-2124
Phone (605) 432-4538

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0674SDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince Mar 1, 2012 Accepting new patients
Avera McKennan CurrentSince Mar 1, 2012 Accepting new patients

Locations

400 22nd Ave
Brookings, SD 57006
Phone (605) 692-6236

1325 S Cliff Ave
Sioux Falls, SD 57105
Phone (605) 322-5000

1417 S Minnesota Ave
Sioux Falls, SD 57105
Phone (605) 336-0515

Organizations & group practices 3

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 23

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1205884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539734400000",
    "number": "1982875803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 86370",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571186370",
            "telephone_number": "605-322-7510",
            "fax_number": "605-322-6475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 S. CLIFF AVE.",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051007",
            "telephone_number": "605-322-4878",
            "fax_number": "605-322-4820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SITTER",
        "first_name": "DEREK",
        "middle_name": "J",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-19",
        "last_updated": "2018-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SD",
            "license": "0674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6830782",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.