Basic Information
| Provider Information | |||||||||
| NPI: | 1720054091 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIPPERDA | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | JOHN | ||||||||
| 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: | 1301 S. CLIFF AVE | ||||||||
| Address2: | STE 401 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227300 | ||||||||
| FaxNumber: | 6053227301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 06/04/2014 | ||||||||
| 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 | 208100000X | 5232 | SD | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 0573089 | 05 | IA | MEDICAID | P00082002 | 01 | SD | RR MEDICARE | OTHER | 414T0RE | 01 | MN | BLUE CROSS | OTHER | 370624200 | 01 | SD | DEPT OF LABOR | OTHER | 1908619 | 01 | SD | ARAZ/ AMERICA'S PPO | OTHER | 2300268 | 01 | SD | MEDICA | OTHER | 432977500 | 05 | MN | MEDICAID | 5232 | 01 | SD | DAKOTACARE | OTHER | HP42931 | 01 | SD | HEALTHPARTNERS | OTHER | 414T0RE | 01 | MN | CC SYSTEMS/ BLUE PLUS | OTHER | 4995937 | 01 | SD | BLUE CROSS | OTHER | 57105K009 | 01 | SD | WPS TRICARE | OTHER | 30863 | 01 | SD | SANFORD HEALTH PLAN | OTHER | 240783 | 01 | SD | MIDLANDS CHOICE | OTHER | 557891034632 | 01 | SD | DAKOTACARE | OTHER | 7101800 | 05 | SD | MEDICAID | 92411422907 | 01 | MN | PRIMEWEST | OTHER | 46022474373 | 05 | NE | MEDICAID |