SAM L MORTIMER M.D.
NPI 1033134135
Pediatrics in Rapid City, SD

Q: What is Sam Mortimer's NPI number?

The NPI number for Sam Mortimer is 1033134135. It was assigned to this individual provider in the NPPES registry on July 12, 2006.

Q: What is Sam Mortimer's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Q: When was this NPI record last updated?

The NPPES record for Sam Mortimer was last updated on January 31, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 12, 2006PECOS Enrolled

2905 5TH ST, RAPID CITY, SD 57701(605) 341-7337(605) 341-2447 Get Directions Write a Review

NPPES record last updated: January 31, 2012. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Sam L Mortimer M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAM L MORTIMER M.D. (NPI 1033134135) is an individual pediatrics provider in Rapid City, South Dakota, licensed in South Dakota (2119) and active in the NPI registry since July 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1033134135

Entity TypeIndividualMale

Primary Taxonomy208000000X

Provider Legal NameSAM L MORTIMERCredential: M.D.

Location Address2905 5TH STRapid City, SD 57701-7316

Mailing Address2905 5th StRapid City, SD 57701-7316 · (605) 341-7337 · Fax (605) 341-2447

Phone(605) 341-7337

Fax(605) 341-2447

Sole ProprietorNo

Enumeration DateJuly 12, 2006

Last NPPES UpdateJanuary 31, 2012

✔ NPI 1033134135 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians

Taxonomy Code208000000X

License✔ Licensed in SD · 2119

Definition

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

2905 5TH ST, Rapid City, SD 57701

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Other Identifiers 3

Medicaid6700210SD

Medicare UPIND25487SD

Medicare ID-Type Unspecified6771SD

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Sam L Mortimer M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Sam Mortimer reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Black Hills Pediatrics, LLP

Same address

Pediatrics

2905 5TH ST
Rapid City, SD 57701

Reassigned Medicare billing, South Dakota enrollment
9 clinicians in this Medicare group

NPI 1639229727 (605) 341-7337

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 57701 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$85.21 typical visit price

range $55.52 – $167.23

Typical copayment $21.30 (range $13.88 – $41.80)

Most-billed visit code 99203

Established Patient

$97.88 typical visit price

range $18.08 – $137.08

Typical copayment $24.47 (range $4.52 – $34.27)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

STEPHEN M KOVARIK M.D.

Pediatrics (Neonatal-Perinatal Medicine)