Basic Information
Provider Information | |||||||||
NPI: | 1508838079 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BEAN | ||||||||
FirstName: | DAVID | ||||||||
MiddleName: | W | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2400 S. MINNESOTA AVE | ||||||||
Address2: | STE 100 | ||||||||
City: | SIOUX FALLS | ||||||||
State: | SD | ||||||||
PostalCode: | 571053762 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6053227510 | ||||||||
FaxNumber: | 6053226475 | ||||||||
Practice Location | |||||||||
Address1: | 4400 W 69TH ST | ||||||||
Address2: | STE 1500 | ||||||||
City: | SIOUX FALLS | ||||||||
State: | SD | ||||||||
PostalCode: | 571088170 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6053225700 | ||||||||
FaxNumber: | 6053225704 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/07/2006 | ||||||||
LastUpdateDate: | 12/11/2013 | ||||||||
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 | 2084P0800X | 2250 | SD | Y |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
ID | Type | State | Issuer | Description | 0040479 | 01 | SD | BLUE CROSS SOUTH DAKOTA | OTHER | 0040479 | 01 | SD | BLUE CROSS | OTHER | 412991028066 | 01 | SD | PREFERRED ONE | OTHER | HP24847 | 01 | SD | HEALTHPARTNERS | OTHER | 2600153 | 05 | OH |   | MEDICAID | 50M78BE | 01 | MN | CC SYSTEMS/ BLUE PLUS | OTHER | 7100033 | 05 | SD |   | MEDICAID | 260050561 | 01 | SD | RR MEDICARE | OTHER | 46022474352 | 05 | NE |   | MEDICAID | 57108C017 | 01 | SD | WPS TRICARE | OTHER | 25137 | 01 | SD | SANFORD HEALTH PLAN | OTHER | 519072000 | 05 | MN |   | MEDICAID | 12200 | 05 | ND |   | MEDICAID | 142431 | 01 | MN | UCARE | OTHER | 14856 | 01 | SD | MIDLANDS CHOICE | OTHER | 1663494 | 01 | SD | ARAZ/ AMERICA'S PPO | OTHER | 1983361 | 05 | IA |   | MEDICAID | 2250 | 01 | SD | DAKOTACARE | OTHER |