Active NPI
David Fossum, PAC
- Physician Assistant
- Pierre, SD
National Provider Identifier
1992757348
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0413
- Practice address
- 101 Mercury St
Pierre, SD 57501-5672 - Phone
- (605) 891-4839
- Fax
- (605) 612-7251
- NPI assigned
- May 16, 2006
- Last updated
- Mar 19, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0413 | SD | Primary |
Addresses
Primary practice location
101 Mercury St
Pierre, SD 57501-5672
Mailing address
101 Mercury St
Pierre, SD 57501-5672
Phone (605) 891-4839
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6826162 | Medicaid | SD |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200611000884 | SD | Order and Referring Only - Physician Assistant | 2769456730 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0413 | SD | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710806400000",
"number": "1992757348",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 MERCURY ST",
"city": "PIERRE",
"state": "SD",
"postal_code": "575015672",
"telephone_number": "605-891-4839",
"fax_number": "612-725-1318"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 MERCURY ST",
"city": "PIERRE",
"state": "SD",
"postal_code": "575015672",
"telephone_number": "605-891-4839",
"fax_number": "605-612-7251"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOSSUM",
"first_name": "DAVID",
"name_prefix": "Mr.",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-16",
"last_updated": "2024-03-19",
"certification_date": "2024-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "SD",
"license": "0413",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6826162",
"state": "SD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pierre, SD
- Elizabeth Ann Fincel, RPH
- Joyce Wesley Fletcher, M.D.
- Whitney Elizabeth Flottmeyer, PHARM D.
- Fort Meade Vamc
- Allison Marie Fosheim, LPC, LPC-MH
- Jessica Foth, LCSW-PIP, LAC, QMHP
- Fresh Life LLC (Pierre Physical Therapy & Rehabilitation)
- Patti Fuchs, RDH
- Shawna K Fullerton, MSW, LCSW
- Justin Michael Gabbert, PA-C
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.