Provider Demographics
NPI:1790758241
Name:BHATARA, VINOD SAGAR (MD)
Entity Type:Individual
Prefix:
First Name:VINOD
Middle Name:SAGAR
Last Name:BHATARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:4400 W 69TH ST
Practice Address - Street 2:STE 1500
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8170
Practice Address - Country:US
Practice Address - Phone:605-322-5700
Practice Address - Fax:605-322-5704
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD24492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD2449OtherDAKOTACARE
ND12200Medicaid
NE46022474352Medicaid
SD4994235OtherBLUE CROSS
SD57108C002OtherWPS TRICARE
MN95G38BHOtherCC SYSTEMS/ BLUE PLUS
SDHP58642OtherHEALTHPARTNERS
MN040121002OtherPRIMEWEST
SD412991012871OtherPREFERRED ONE
MN828893300Medicaid
SD25067OtherARAZ/ AMERICA'S PPO
IA4122952Medicaid
SD9338OtherMIDLANDS CHOICE
SD370624200OtherDEPT OF LABOR
SD28928OtherSANFORD HEALTH PLAN
SDA02569Medicare UPIN
SD9338OtherMIDLANDS CHOICE
IA4122952Medicaid