Healthcare Provider Details
I. General information
NPI: 1639141179
Provider Name (Legal Business Name): SCOTT A SCHNEIDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 02/07/2006
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
4400 W 69TH ST STE 500
SIOUX FALLS SD
57108-8170
US
IV. Provider business mailing address
2400 S MINNESOTA AVE STE 100
SIOUX FALLS SD
57105-3761
US
V. Phone/Fax
- Phone: 605-322-7580
- Fax: 605-322-7579
- Phone: 605-322-7510
- Fax: 605-322-6475
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2084P0804X |
| Taxonomy | Child & Adolescent Psychiatry Physician |
| License Number | 3666 |
| License Number State | SD |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 12242 |
| Identifier Type | MEDICAID |
| Identifier State | ND |
| Identifier Issuer | |
| # 2 | |
| Identifier | 25266 |
| Identifier Type | OTHER |
| Identifier State | SD |
| Identifier Issuer | SANFORD HEALTH PLAN |
| # 3 | |
| Identifier | 260040364 |
| Identifier Type | OTHER |
| Identifier State | SD |
| Identifier Issuer | RR MEDICARE |
| # 4 | |
| Identifier | 57108D003 |
| Identifier Type | OTHER |
| Identifier State | SD |
| Identifier Issuer | WPS TRICARE |
| # 5 | |
| Identifier | 769191017550 |
| Identifier Type | OTHER |
| Identifier State | SD |
| Identifier Issuer | PREFERRED ONE |
| # 6 | |
| Identifier | 10378 |
| Identifier Type | OTHER |
| Identifier State | SD |
| Identifier Issuer | MIDLANDS CHOICE |
| # 7 | |
| Identifier | 512428 |
| Identifier Type | OTHER |
| Identifier State | SD |
| Identifier Issuer | ARAZ/ AMERICA'S PPO |
| # 8 | |
| Identifier | 7100932 |
| Identifier Type | MEDICAID |
| Identifier State | SD |
| Identifier Issuer | |
| # 9 | |
| Identifier | 92411422904 |
| Identifier Type | OTHER |
| Identifier State | MN |
| Identifier Issuer | PRIMEWEST |
| # 10 | |
| Identifier | HP24841 |
| Identifier Type | OTHER |
| Identifier State | SD |
| Identifier Issuer | HEALTHPARTNERS |
| # 11 | |
| Identifier | 0002827 |
| Identifier Type | OTHER |
| Identifier State | SD |
| Identifier Issuer | BLUE CROSS |
| # 12 | |
| Identifier | 0033303 |
| Identifier Type | MEDICAID |
| Identifier State | MT |
| Identifier Issuer | |
| # 13 | |
| Identifier | 1908517 |
| Identifier Type | MEDICAID |
| Identifier State | IA |
| Identifier Issuer | |
| # 14 | |
| Identifier | 296265900 |
| Identifier Type | MEDICAID |
| Identifier State | MN |
| Identifier Issuer | |
| # 15 | |
| Identifier | 3666 |
| Identifier Type | OTHER |
| Identifier State | SD |
| Identifier Issuer | DAKOTACARE |
| # 16 | |
| Identifier | 46022474340 |
| Identifier Type | MEDICAID |
| Identifier State | NE |
| Identifier Issuer | |
| # 17 | |
| Identifier | 3T022SC |
| Identifier Type | OTHER |
| Identifier State | MN |
| Identifier Issuer | CC SYSTEMS/ BLUE PLUS |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
