CORNELIUS F BOERKOEL III (NPI# 1902266273) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902266273 |
| Entity Type | Individual |
| Full Name | CORNELIUS F BOERKOEL III |
| Practice Address |
1205 S Grange Ave Ste 510 Sioux Falls SD 57105-0410 |
| Mailing Address |
Po Box 5074 Sioux Falls SD 57117-5074 |
| Practice Telephone | 6053287500 |
| Practice Fax Number | 6053287599 |
| Enumeration Date | 2016-03-01 |
| Last Update Date | 2016-03-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207SG0201X |
Medical Genetics Specialization: Clinical Genetics (M.D.) |
9765 | SD | Allopathic & Osteopathic Physicians |
| Street Address |
1205 S GRANGE AVE STE 510 |
| City | SIOUX FALLS |
| State | SD |
| Zip Code | 57105-0410 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518973221 | Sanford Clinic | Internal Medicine | 1205 S Grange Ave Ste 510, Sioux Falls, SD 57105-0410 | 2006-08-01 |
| 1023585833 | Lyndsey Sue Horne | Nurse Practitioner | 1205 S Grange Ave Ste 510, Sioux Falls, SD 57105-0410 | 2018-10-30 |
| 1962978726 | Laura A Bakke | Physician Assistant | 1205 S Grange Ave Ste 510, Sioux Falls, SD 57105-0410 | 2018-10-19 |
| 1245713361 | Ashley Frost | Family Medicine | 1205 S Grange Ave Ste 510, Sioux Falls, SD 57105-0410 | 2018-09-13 |
| 1508251059 | Paresh M. Sojitra | Internal Medicine | 1205 S Grange Ave Ste 510, Sioux Falls, SD 57105-0410 | 2015-04-01 |
| 1437564820 | Antonios Wehbeh | Internal Medicine | 1205 S Grange Ave Ste 510, Sioux Falls, SD 57105-0410 | 2014-06-25 |
| 1205254547 | Parkpoom Phatharacharukul | Internal Medicine | 1205 S Grange Ave Ste 510, Sioux Falls, SD 57105-0410 | 2014-04-03 |
| 1316242365 | Andrea Joy Eben | Social Worker | 1205 S Grange Ave Ste 510, Sioux Falls, SD 57105-0410 | 2011-01-24 |
| 1568654648 | Mark Gene Lounsbery | Internal Medicine | 1205 S Grange Ave Ste 510, Sioux Falls, SD 57105-0410 | 2007-08-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871117549 | Ashlesha Ravindra Bagwe | Student in an Organized Health Care Education/Training Program | Pediatrics Residency Program, 1305 W 18th St, Rt 6364, Sioux Falls, SD 57105 | 2020-05-29 |
| 1306494489 | Kelsey Elaine Kruse | Counselor | 3101 West 41st, Sioux Falls, SD 57105 | 2019-08-30 |
| 1902388341 | Sarah Tacke | Nurse Practitioner | 1301 West 18th Street, Sioux Falls, SD 57105 | 2018-09-02 |
| 1235624727 | Mahum Shahid | Student in an Organized Health Care Education/Training Program | 1400 W. 22nd St, Sioux Falls, SD 57105 | 2018-06-27 |
| 1942790126 | Smitha Narayana Gowda | Student in an Organized Health Care Education/Training Program | 1400 22nd Street, Sioux Falls, SD 57105 | 2018-05-14 |
| 1326538554 | Mali Elizabeth Teller | Speech-Language Pathologist | 2501 W. 26th Street, Sioux Falls, SD 57105 | 2018-05-14 |
| 1871081505 | Abdelmohaymin Abdalla Abufatima Abdalla | Student in an Organized Health Care Education/Training Program | Usd-ssom-internal Medicine Residency, 1400 22nd Street, Sioux Falls, SD 57105 | 2018-04-27 |
| 1710474697 | Moataz Ellithi | Student in an Organized Health Care Education/Training Program | 1400 W. 22nd St., Sioux Falls, SD 57105 | 2018-04-17 |
| 1366948663 | Holly Ahlers | Registered Nurse | 2000 S. Summit Ave, Sioux Falls, Sd 57105, Sioux Falls, SD 57105 | 2018-04-04 |
| 1558864124 | Darcy Lee Jensen | Counselor | 822 East 41st. Street, Suite 235, Souix Falls, SD 57105 | 2018-03-09 |
| Find all providers in zip 57105 | ||||
| Taxonomy Code | 207SG0201X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Medical Genetics |
| Specialization | Clinical Genetics (M.D.) |
| A clinical geneticist demonstrates competence in providing comprehensive diagnostic, management and counseling services for genetic disorders. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Medical Genetics, 2007. http://www.abmg.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Medical Genetics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811263627 | David Isum Ward | Medical Genetics | 1600 W 22nd St, Sioux Falls, SD 57105 | 2012-03-26 |
| 1588871859 | Jason Lewis Picconi | Medical Genetics | 1417 S Cliff Ave, Plaza 1, Suite 100, Sioux Falls, SD 57105-1022 | 2007-05-17 |
| 1356394324 | Laura A Davis Keppen | Medical Genetics | 1600 W 22nd St, Sioux Falls, SD 57105-1521 | 2006-05-18 |
| 1851385041 | Virginia P Johnson | Medical Genetics | 1310 W 22nd St, Sioux Falls, SD 57105-1501 | 2005-09-02 |
| City | SIOUX FALLS |
| Zip Code | 57105 |
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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.