Basic Information
| Provider Information | |||||||||
| NPI: | 1053419903 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAFFAR | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 86370 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571186370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227510 | ||||||||
| FaxNumber: | 6053226475 | ||||||||
| Practice Location | |||||||||
| Address1: | 6100 S LOUISE AVE STE 1120 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571086021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6055041700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 10/31/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | CP000478 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 46022474335 | 05 | NE | MEDICAID | 769201048412 | 01 | SD | PREFERRED ONE | OTHER | HP71462 | 01 | SD | HEALTHPARTNERS | OTHER | 070107000 | 05 | MN | MEDICAID | 2444134 | 01 | SD | ARAZ/ AMERICA'S PPO | OTHER | 0545186 | 05 | IA | MEDICAID | CP000478 | 01 | SD | CNP LICENSE | OTHER | 0125073 | 01 | SD | MEDICA | OTHER | 4993678 | 01 | SD | BLUE CROSS | OTHER | 500L7KA | 01 | MN | CC SYSTEMS/ BLUE PLUS | OTHER | 57105F018 | 01 | SD | WPS TRICARE | OTHER | 92411422901 | 01 | MN | PRIMEWEST | OTHER | P00446747 | 01 | SD | RR MEDICARE | OTHER | 370624200 | 01 | SD | DEPT OF LABOR | OTHER | 251572 | 01 | SD | MIDLANDS CHOICE | OTHER | 9240659 | 01 | SD | DAKOTACARE | OTHER | R027066 | 01 | SD | RN LICENSE | OTHER |