Dale E Vizcarra, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

SD3600 Issued in SD

Practice address

100 Mac Lane
Avera Medical Group Pierre
Pierre, SD 57501

Phone

(605) 224-5901

Fax

(605) 945-5096

NPI assigned

Apr 7, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Pediatric Hematology Clinic LTD

  • Pediatric Hematology & Oncology Physician
  • Sioux Falls, SD
  • NPI 1003956343
  NPD (past)
• Pediatric Hematology Oncology Pharmacy LTC

  • Pharmacy
  • Sioux Falls, SD
  • NPI 1952436099
  NPD (past)

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

{
    "created_epoch": "1144368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335484800000",
    "number": "1992768469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MAC LANE",
            "address_2": "AVERA MEDICAL GROUP PIERRE",
            "city": "PIERRE",
            "state": "SD",
            "postal_code": "57501",
            "telephone_number": "605-224-5901",
            "fax_number": "605-945-5096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MAC LANE",
            "address_2": "AVERA MEDICAL GROUP PIERRE",
            "city": "PIERRE",
            "state": "SD",
            "postal_code": "57501",
            "telephone_number": "605-224-5901",
            "fax_number": "605-945-5096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIZCARRA",
        "first_name": "DALE",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-07",
        "last_updated": "2012-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "3600",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "SD3600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5609172",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5609170",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vilas Long Term Care Pharmacy
• Vilas Pharmacy
• Joseph Simon Villa, MD
• Danielle Diann Vis
• Visionary Mental Health Services, LLC
• Rodney T Vizcarra, MD
• Christine Kay Wagner IV, PTA
• Wal-Mart Stores, Inc.
• Ashley Waldner
• Walgreen Co

• All providers in Pierre, SD
• Family Medicine Physician in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.