NPIMap

Individual provider Active NPI

Mary E Kurniawan, LICSW

  • Clinical Social Worker
  • Rapid City, SD
National Provider Identifier
1992242762
Registry record updated Apr 24, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
3497 Issued in SD
Practice address
915 Mt View Rd
Rapid City, SD 57702-3414
Phone
(605) 755-7300
Fax
(605) 755-0707
NPI assigned
Jan 31, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 24, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 3497 SD Primary

Addresses

Primary practice location

915 Mt View Rd
Rapid City, SD 57702-3414

Mailing address

353 Fairmont Blvd
Rapid City, SD 57701-7375
Phone (605) 755-8110

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
I20170316001463 SD Practitioner - Clinical Social Worker 8123303088 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

353 Fairmont Blvd
Rapid City, SD 57701-7375
Phone (605) 755-8109

502 E Monroe St
Rapid City, SD 57701-1400
Phone (605) 755-4060

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3497SDMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Monument Health Rapid City Hospital, Inc CurrentSince Feb 8, 2017 Accepting new patients
Monument Health Rapid City Hospital Inc CurrentSince Feb 8, 2017 Accepting new patients

Locations

915 Mountain View Rd
Rapid City, SD 57702
Phone (605) 719-7200

353 Fairmont Blvd
Rapid City, SD 57701
Phone (605) 719-1000

Organizations & group practices 2

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 12

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": "1485820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492992000000",
    "number": "1992242762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "353 FAIRMONT BLVD",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577017375",
            "telephone_number": "605-755-8110",
            "fax_number": "605-755-0707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 MT VIEW RD",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577023414",
            "telephone_number": "605-755-7300",
            "fax_number": "605-755-0707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KURNIAWAN",
        "first_name": "MARY",
        "middle_name": "E",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-01-31",
        "last_updated": "2017-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "SD",
            "license": "3497",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rapid City, SD

Sources for this page

Verify at the official NPI Registry.