DR. CALLIE PEDERSON (NPI# 1568991446) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568991446 |
| Entity Type | Individual |
| Full Name | DR. CALLIE PEDERSON |
| Credential | D.O. |
| Practice Address |
28th Medical Group 2900 Doolitle Drive Ellsworth Afb SD 57706-4821 |
| Mailing Address |
2900 Doolittle Drive 2900 Doolittle Drive Rapid City SD 57702-9144 |
| Practice Telephone | 6053853111 |
| Mailing Telephone | 6053853111 |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2020-07-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 0102205476 | VA | Allopathic & Osteopathic Physicians |
| N | 171000000X | Military Health Care Provider | Other Service Providers |
| Street Address |
28TH MEDICAL GROUP 2900 DOOLITLE DRIVE |
| City | ELLSWORTH AFB |
| State | SD |
| Zip Code | 57706-4821 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801307202 | Patrick David Jones | Physician Assistant | 28th Mdg/sggp, 2900 Doolittle Dr., Ellsworth Afb, SD 57706 | 2017-10-12 |
| 1770736522 | Amy Marie Kubal | Dietitian, Registered | 2450 Risner Drive, Ellsworth Air Force Base Health and Wellness Center, Ellsworth Afb, SD 57706 | 2008-10-24 |
| 1629576491 | Mario Luis Recupido IIi | Military Health Care Provider | 2900 Doolittle Dr, Ellsworth Afb, SD 57706 | 2018-01-26 |
| 1104337450 | Michael J Vadovsky | Physician Assistant | 2900 Doolittle Dr, Ellsworth Afb, SD 57706 | 2017-10-13 |
| 1275057754 | Adrianne Rae Littles | Military Health Care Provider | 2900 Doolittle Drive, Ellsworth Afb, SD 57706 | 2017-07-27 |
| 1780045427 | Dustin Ross Mayne | Pediatrics | 2900 Doolittle Dr, Ellsworth Afb, SD 57706 | 2016-03-08 |
| 1588993315 | Denise D Carcamo | Nurse Practitioner | 2900 Doolittle Dr, Ellsworth Afb, SD 57706 | 2009-12-07 |
| 1235363789 | Gregory Thomas Trifilo | Family Medicine | 2900 Doolittle Dr, Ellsworth Afb, SD 57706 | 2009-05-13 |
| 1982880563 | Sarah Zimmerman | Social Worker | 2900 Doolittle Dr, Ellsworth Afb, SD 57706 | 2008-01-14 |
| 1467501874 | Tasha Dee Standing Soldier | Pharmacist | 2900 Doolittle Drive, 28th Medical Group, Ellsworth Afb, SD 57706 | 2007-01-09 |
| Find all providers in zip 57706 | ||||
| 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 |
|---|---|---|---|---|
| 1013365832 | Andrew Pellegrin | Family Medicine | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2016-06-02 |
| 1457764037 | Nathaniel John Renes | Family Medicine | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2014-06-11 |
| 1114247459 | Adam Hebdon | Family Medicine | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2010-06-09 |
| 1235363789 | Gregory Thomas Trifilo | Family Medicine | 2900 Doolittle Dr, Ellsworth Afb, SD 57706 | 2009-05-13 |
| 1629090212 | Cecelia Mariko Tatsumi | Family Medicine | 2900 Doolittle Dr, Ellsworth Afb, SD 57706-4821 | 2006-07-24 |
| 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 |
| 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 |
| 1932514080 | Lawrence Nelson | Family Medicine | 13806 436th Ave, Webster, SD 57274-5616 | 2014-06-27 |
| Find all providers with the same taxonomy | ||||
| City | ELLSWORTH AFB |
| Zip Code | 57706 |
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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.