Provider Demographics
NPI:1083671408
Name:JENSEN, RICHARD A (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5126
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5126
Mailing Address - Country:US
Mailing Address - Phone:605-335-1952
Mailing Address - Fax:605-373-9971
Practice Address - Street 1:2333 W 57TH ST STE 101
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5054
Practice Address - Country:US
Practice Address - Phone:605-496-7667
Practice Address - Fax:605-496-7699
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3923207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1963462Medicaid
MN14G07JEOtherBCBS
SD6630172Medicaid
SD4997594OtherBCBS
MN395781100Medicaid
IA09466OtherBCBS
NE22305OtherBCBS
SD390005700OtherRAILROAD
F00328Medicare UPIN
IA09466OtherBCBS
MN14G07JEOtherBCBS
SD6630172Medicaid
MN390000302Medicare PIN