DR. PEDRO H IBARRA-PEROCIER (NPI# 1710961081) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710961081 |
| Entity Type | Individual |
| Full Name | DR. PEDRO H IBARRA-PEROCIER |
| Credential | M.D. |
| Practice Address |
111 Washington Ave Nw Wagner SD 57380-4300 |
| Practice Telephone | 6053843621 |
| Practice Fax Number | 6053845229 |
| Mailing Telephone | 6053843621 |
| Mailing Fax Number | 6053845229 |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2011-10-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | 14413 | PR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PR | MEDICARE Y MUCHO MAS | 100284W | 01 |
| PR | PREFERRED MEDICARE CHOICE | 3258 | 01 |
| PR | FIRST MEDICAL | A468 | 01 |
| SD | I.H.S. WAGNER | 1326066796 | 01 |
| Street Address |
111 WASHINGTON AVE NW |
| City | WAGNER |
| State | SD |
| Zip Code | 57380-4300 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639650328 | Amanda Neyhart | Pharmacist | 111 Washington Ave Nw, Wagner, SD 57380-4300 | 2018-08-22 |
| 1053861096 | Judy Cuka | Registered Nurse | 111 Washington Ave Nw, Wagner, SD 57380-4300 | 2016-10-13 |
| 1154797165 | Rishi Patel | General Practice | 111 Washington Ave Nw, Wagner, SD 57380-4300 | 2015-08-13 |
| 1205234481 | Joshua Woods | Pharmacist | 111 Washington Ave Nw, Wagner, SD 57380-4300 | 2014-12-19 |
| 1649686080 | Melody Otte | Nurse Practitioner | 111 Washington Ave Nw, Wagner, SD 57380-4300 | 2014-07-07 |
| 1437582053 | Brittany Marie Rothschadl | Physical Therapist | 111 Washington Ave Nw, Wagner, SD 57380-4300 | 2013-08-19 |
| 1568778959 | Joan Fillaus | Dental Hygienist | 111 Washington Ave Nw, Wagner, SD 57380-4300 | 2010-08-24 |
| 1588805816 | Colleen R Permann | Registered Nurse | 111 Washington Ave Nw, Wagner, SD 57380-0111 | 2009-03-17 |
| 1396986626 | Craig A Noteboom | Registered Nurse | 111 Washington Ave Nw, Wagner, SD 57380-0111 | 2009-03-17 |
| 1881847028 | Michelle Olson | Physician Assistant | 111 Washington Ave Nw, Wagner, SD 57380-4300 | 2008-10-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083070593 | Carol Lee Stewart | Nurse Practitioner | 513 3rd Street Sw, Wagner, SD 57380 | 2016-01-13 |
| 1174906705 | Jerika Kirwan | Optometrist | 720 West Hwy 46, Wagner, SD 57380 | 2015-07-01 |
| 1134334766 | Drew Tyler Anderson | Chiropractor | 109 1st St Sw, Wagner, SD 57380 | 2007-05-14 |
| 1326066796 | Wagner Indian Health Service Health Center | Clinic/Center | 111 Washington Ave, Wagner, SD 57380 | 2006-07-17 |
| 1447220603 | Jay Joseph Fitzgerald | Chiropractor | 109 1st. St. Sw, Wagner, SD 57380 | 2006-01-23 |
| 1649759499 | The Evangelical Lutheran Good Samaritan Society | Nurse Practitioner | 515 W Highway 46, Wagner, SD 57380 | 2018-08-13 |
| 1205973732 | James Pharmacy Inc | Pharmacy | 201 Main St., Wagner, SD 57380 | 2007-02-01 |
| 1679653208 | Julie Kristina Williams | Optometrist | 111 Washington Ave, Wagner Indian Health Services, Wagner, SD 57380 | 2006-10-17 |
| 1477575827 | Mark Struble | Optometrist | 121 S Main Ave, Wagner, SD 57380 | 2006-07-24 |
| 1326060054 | Sanford Medical Center | Clinic/Center | 111 Washington St, Wagner, SD 57380 | 2006-07-24 |
| Find all providers in zip 57380 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154797165 | Rishi Patel | General Practice | 111 Washington Ave Nw, Wagner, SD 57380-4300 | 2015-08-13 |
| 1962509075 | Edgardo Toro Velez | General Practice | 111 Washington Ave Nw, Wagner, SD 57380-4300 | 2006-09-20 |
| 1538266655 | Maria Michelle Rivera Ortiz | General Practice | 111 Washington Ave Nw, Wagner, SD 57380-4300 | 2006-09-20 |
| 1740232925 | Grisel Rodriguez-diaz | General Practice | 111 Washington Ave Nw, Wagner, SD 57380-4300 | 2006-05-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396383329 | Lmmc Sioux Falls, LLC | General Practice | 5919 S Remington Pl, Sioux Falls, SD 57108-5143 | 2019-12-20 |
| 1376838839 | Paul Thrasher Denna | General Practice | 803 E. Milbank Ave., Milbank, SD 57252 | 2011-06-13 |
| 1740519073 | Joselyn Agosto-betancourt | General Practice | East Highway 18 Ihs Compound, Pine Ridge, SD 57770-1201 | 2009-12-16 |
| 1679756399 | Johanna Militza Camacho | General Practice | 24276 166 Th St Airport Road, Eagle Butte, SD 57625 | 2007-12-17 |
| 1912187865 | Steven Michael Burtz | General Practice | 1702 Main St, Tyndall, SD 57066 | 2007-11-08 |
| 1366647893 | Julio Enrique Almeyda | General Practice | 24276 166 St Airport Road, Eagle Butte, SD 57625-1155 | 2007-06-15 |
| 1548477565 | Arlene Flores | General Practice | Camino Aviles Res Carr 830, Km5.2 Cerro Gordo, Bayamon, SD 00956-9606 | 2007-05-17 |
| 1063630150 | Elizabeth Anne Pearl | General Practice | 7037 Freedom Ct, Apt B, Summerset, SD 57718-8712 | 2007-04-23 |
| 1942382585 | Robert C. Preston | General Practice | 408 Knollwood Dr, Rapid City, SD 57701-0600 | 2006-10-20 |
| 1083624241 | Antonio Mora Alandy | General Practice | 200 J Ave Ste A, Eureka, SD 57437-2225 | 2006-08-09 |
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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.