WEST RIVER DERMATOLOGY, PC (NPI# 1013010974) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013010974 |
| Entity Type | Organization |
| Organization Name | WEST RIVER DERMATOLOGY, PC |
| Practice Address |
717 Meade St Suite 100 Rapid City SD 57701-5100 |
| Practice Telephone | 6053415910 |
| Practice Fax Number | 6053419052 |
| Mailing Telephone | 6053415910 |
| Mailing Fax Number | 6053419052 |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2008-03-11 |
| Authorized Official Name | DR. ROGER S KNUTSEN (PRESIDENT) |
| Authorized Official Telephone | 6053415910 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
0266 | SD | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SD | BLUE CROSS BLUE SHIELD | 0003099 | 01 |
| Street Address |
717 MEADE ST SUITE 100 |
| City | RAPID CITY |
| State | SD |
| Zip Code | 57701-5100 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972573707 | Roger Steven Knutsen | Dermatology | 717 Meade St, Suite 100, Rapid City, SD 57701-5103 | 2006-01-24 |
| 1073068474 | Wyley Wondercheck Dds PC | Dentist | 717 Meade St, Ste 200, Rapid City, SD 57701-5103 | 2016-08-16 |
| 1659696672 | Siri Shirene Knutsen Larson | Dermatology | 717 Meade St, Suite 100, Rapid City, SD 57701-5103 | 2010-04-01 |
| 1275754608 | David A Rempel, Dds P.C. | Dentist | 717 Meade St, Ste. 400, Rapid City, SD 57701-5103 | 2007-05-02 |
| 1265460091 | David Alan Rempel | Dentist | 717 Meade St, Ste. 400, Rapid City, SD 57701-5103 | 2006-06-29 |
| 1003886839 | Karen Kay Zepp | Physician Assistant | 717 Meade St, Suite 100, Rapid City, SD 57701-5103 | 2006-01-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528623345 | Julie Maas | Counselor | 625 1/2 Main St, Suite 1, Rapid City, SD 57701 | 2019-05-07 |
| 1972076024 | Edgewood Rapid City LLC | Assisted Living Facility | 4001 Derby Lane, Rapid City, SD 57701 | 2019-01-10 |
| 1902300247 | Theresa Gibbens | Speech-Language Pathologist | 3301 Grandview Drive, Rapid City, SD 57701 | 2018-03-21 |
| 1407355423 | Arielle Leigh Loveridge | Chiropractor | 610 East Boulevard, Suite 1, Rapid City, SD 57701 | 2018-02-05 |
| 1083125082 | Sarah Kirschman | Nurse Practitioner | 353 Fairmont Boulvevard, Rapid City, SD 57701 | 2017-10-17 |
| 1992225239 | Kelsey Elizabeth Wondercheck | Dentist | 717 Meade Street, Suite 200, Rapid City, SD 57701 | 2017-06-27 |
| 1316476088 | Rhianna Wickett | Physical Therapist | 420 E Saint Patrick St Ste 101, Rapid City, SD 57701 | 2017-06-07 |
| 1841727773 | Cynthia A Gates | Dietitian, Registered | 2908 5th Street, Rapid City, SD 57701 | 2017-05-23 |
| 1811447758 | Alyssa Marquardt | Psychologist | 433 Mt. Rushmore Road, Rapid City, SD 57701 | 2016-10-04 |
| 1578913232 | .indian Health Service | Clinic/Center | 241 East Meade St, Rapid City, SD 57701 | 2016-06-14 |
| Find all providers in zip 57701 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497727028 | Black Hills Dermatology PC | Dermatology | 7236 Jordan Drive Suite 101, Rapid City, SD 57702-8740 | 2006-02-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689831091 | Black Hills Dermatology PC | Dermatology | 132 E Grant St, Spearfish, SD 57783-2424 | 2008-05-22 |
| City | RAPID CITY |
| Zip Code | 57701 |
Please comment or provide details below to improve the information on WEST RIVER DERMATOLOGY, PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.