Basic Information
| Provider Information | |||||||||
| NPI: | 1972577880 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHAFER | ||||||||
| FirstName: | LARRY | ||||||||
| MiddleName: | WILLIAM | ||||||||
| 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: | 1417 S. CLIFF AVE. | ||||||||
| Address2: | STE. 300 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053228630 | ||||||||
| FaxNumber: | 6053228631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 11/19/2014 | ||||||||
| 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 | 207RG0100X | 1541 | SD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 0040344 | 01 | SD | BLUE CROSS | OTHER | 10662 | 01 | SD | MIDLANDS CHOICE | OTHER | 1541 | 01 | SD | DAKOTACARE | OTHER | 57105B004 | 01 | SD | WPS TRICARE | OTHER | 20854 | 01 | SD | SANFORD HEALTH PLAN | OTHER | 127106 | 01 | MN | UCARE | OTHER | 479075800 | 05 | MN | MEDICAID | 6001292 | 05 | SD | MEDICAID | HP24767 | 01 | SD | HEALTHPARTNERS | OTHER | 100016415 | 01 | SD | RR MEDICARE | OTHER | 2900243 | 01 | SD | MEDICA | OTHER | 125M9SC | 01 | MN | BLUE CROSS | OTHER | 125M9SC | 01 | MN | CC SYSTEMS/ BLUE PLUS | OTHER | 22863 | 01 | SD | ARAZ/ AMERICA'S PPO | OTHER | XPY205856 | 05 | CA | MEDICAID | 1913624 | 05 | IA | MEDICAID | 46022474338 | 05 | NE | MEDICAID | 769171028152 | 01 | SD | PREFERRED ONE | OTHER |