JASON W. WICKERSHAM (NPI# 1073594172) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073594172 |
| Entity Type | Individual |
| Full Name | JASON W. WICKERSHAM |
| Credential | M.D. |
| Practice Address |
401 W Glynn Dr Parkston SD 57366-9605 |
| Practice Telephone | 6059283311 |
| Practice Fax Number | 6059287368 |
| Mailing Telephone | 6059283311 |
| Mailing Fax Number | 6059287368 |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2012-08-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 5450 | SD | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SD | 5611620 | 05 | |
| SD | 5340340 | 05 | |
| SD | 5340070 | 05 | |
| SD | WELLMARK | 4995341 | 01 |
| Street Address |
401 W GLYNN DR |
| City | PARKSTON |
| State | SD |
| Zip Code | 57366-9605 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982695656 | Candyce J Scherr | Physician Assistant | 401 W Glynn Dr, Parkston, SD 57366-9605 | 2005-11-02 |
| 1962936856 | Paul David Berndt | Family Medicine | 401 W Glynn Dr, Parkston, SD 57366-9605 | 2017-04-18 |
| 1447799846 | Heather Hisek-prunty | Physical Therapist | 401 W Glynn Dr, Parkston, SD 57366-9605 | 2017-02-17 |
| 1811436264 | Rebecca Schultz | Physical Therapist | 401 W Glynn Dr, Parkston, SD 57366-9605 | 2017-02-17 |
| 1629461520 | Vicki Lubbers | Nurse Practitioner | 401 W Glynn Dr, Parkston, SD 57366-9605 | 2015-03-17 |
| 1841600038 | Avera At Home | In Home Supportive Care | 401 W Glynn Dr, Parkston, SD 57366-9605 | 2014-04-28 |
| 1811310113 | Amanda Whittington | Physical Therapist | 401 W Glynn Dr, Parkston, SD 57366-9605 | 2014-01-23 |
| 1770867715 | Lindsay Rae Weber | Nurse Practitioner | 401 W Glynn Dr, Parkston, SD 57366-9605 | 2011-10-10 |
| 1912216474 | Avera St Benedict Health Center | General Acute Care Hospital | 401 W Glynn Dr, Parkston, SD 57366-9605 | 2010-10-01 |
| 1184944860 | Denise A Leischner | Physical Therapist | 401 W Glynn Dr, Parkston, SD 57366-9605 | 2010-06-04 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578635108 | Varney Pharmacy LLC | Pharmacy | 102 West Main, Parkston, SD 57366 | 2006-11-15 |
| 1821185414 | St Benedict Health Center | Assisted Living Facility | 401 W Glynn Drive, Parkston, SD 57366 | 2006-10-06 |
| 1215959770 | Leroy Kaufman | Optometrist | 118 E Main, Parkson, SD 57366 | 2006-07-24 |
| 1912990565 | Jessica Ann Wolf | Chiropractor | 103 West Glynn Drive, Parkston, SD 57366 | 2005-08-30 |
| 1255896072 | Dynamic Chiropractic Prof LLC | Chiropractor | 310 E Main St, Parkston, SD 57366 | 2019-02-06 |
| 1730208919 | Parkston Rural Ambulance District | Ambulance | 207 W Main St, Parkston, SD 57366 | 2007-03-28 |
| 1922196385 | St Benedict Health Center | Skilled Nursing Facility | 401 W Glynn Drive, Parkston, SD 57366 | 2006-10-11 |
| 1285659466 | Parkston Chiropractic Clinic, Prof. L.L.C. | Chiropractor | 103 West Glynn Drive, Parkston, SD 57366 | 2006-07-12 |
| 1508933714 | Thomas Herman Neumayr | Pharmacist | 112 S Main St, Parkston, SD 57366-0430 | 2006-11-30 |
| 1801917281 | Parkston Drug Inc | Durable Medical Equipment & Medical Supplies | 112 W Main St, Parkston, SD 57366-2010 | 2007-04-03 |
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| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962936856 | Paul David Berndt | Family Medicine | 401 W Glynn Dr, Parkston, SD 57366-9605 | 2017-04-18 |
| 1295758266 | St Benedict Health Center | Family Medicine | 401 W Glynn Dr, Parkston, SD 57366-9605 | 2006-07-25 |
| 1104807858 | Richard W. Honke II | Family Medicine | 401 W Glynn Dr, Parkston, SD 57366-9605 | 2005-11-09 |
| 1689655789 | Antoinette J Vander Pol | Family Medicine | 401 W Glynn Dr, Parkston, SD 57366-9605 | 2005-11-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396343505 | Kaitlyn Mae Fritz | Family Medicine | Wellness Center 103, Brookings, SD 57007-0001 | 2020-10-12 |
| 1447877386 | Black Hills Primary Care PC | Family Medicine | 8075 Stage Stop Rd., Summerset, SD 57718 | 2020-06-26 |
| 1467003251 | Arthur Lampert | Family Medicine | 1770 Tablerock Rd Apt 120, Rapid City, SD 57701-5586 | 2019-09-24 |
| 1851883540 | Modern Day Health Care Prof LLC | Family Medicine | 125 Railroad Ave Se, Aberdeen, SD 57401-4202 | 2018-05-30 |
| 1427555002 | Sanford Clinic | Family Medicine | 136 S Phillips Ave Ste 102, Sioux Falls, SD 57104 | 2018-04-10 |
| 1023524741 | Quick Health Urgent Care LLC | Family Medicine | 7600 S Louise Ave Ste 150, Sioux Falls, SD 57108-5999 | 2017-12-18 |
| 1568991446 | Callie Pederson | Family Medicine | 28th Medical Group, 2900 Doolitle Drive, Ellsworth Afb, SD 57706-4821 | 2017-06-05 |
| 1144751256 | Maya Itza Koehler | Family Medicine | 534 Oregon Ave Se, Huron, SD 57350-2801 | 2017-03-22 |
| 1578004883 | Sacred Heart Health Services | Family Medicine | 2525 Fox Run Pkwy Ste 200, Yankton, SD 57078-5371 | 2017-03-20 |
| 1073992004 | Monument Health Network, Inc. | Family Medicine | 209 Ramsland St, Buffalo, SD 57720-0045 | 2015-05-22 |
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| 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.