STACY DANIELSON (PA) – Physician Assistant, NPI 1114395597
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
639 PHYSICIAN ASSISTANT in SD
Provider Addresses for STACY DANIELSON (PA)
PO BOX 2257
CHESTERTON, IN 463040357
Phone: (219) 926-8320
Fax: (219) 926-3524
Type: Mailing
1818 W FULTON ST STE 102
RAPID CITY, SD 577024347
Phone: (605) 787-1040
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 11 Open Payments records for all available years, with a total value of $675.
Total Amount is formed as General ($675) + Research ($0) + Ownership ($0) = $675.
Last reported payment date: 2024-12-19 • Largest payer in this snapshot: Axsome Therapeutics, Inc. ($216).
Total Amount
$675
General + Research + Ownership
Payments
11
Total payment records
General Amount
$675
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-19
Latest reported date
Top Companies
Largest payers in this snapshot
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2015-11-02
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20151102000882 | I | Physician Assistant | SD | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 46304)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | SD | |
| - | SD | |
| Vascular Surgery, Thoracic Surgery, Thoracic Surgery, Cardiac Surgery | SC | |
| - | SD | |
| - | SD | |
| Cardiovascular Disease (Cardiology) | OH | |
| Nurse Practitioner | PA | |
| Nurse Practitioner | SD | |
| - | SD | |
| U R O L O G Y | KS |
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