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TRI STATE MEDICAL CENTER PLLC
NPI 1073390944
Nurse Practitioner in Belle Fourche, SD

Active since September 13, 2023
2398 5TH AVE STE 101, BELLE FOURCHE, SD 57717(605) 645-2064 Get Directions Write a Review

NPPES record last updated: January 11, 2024. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Tri State Medical Center Pllc NPPES

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

TRI STATE MEDICAL CENTER PLLC (NPI 1073390944) is a healthcare organization registered as a nurse practitioner in Belle Fourche, South Dakota and active in the NPI registry since September 2023. The organization lists Vanessa Kudlock, Owner, as its authorized official.

NPPES Registry Identity

NPI1073390944
Entity TypeOrganization
Primary Taxonomy363L00000X
Legal Business NameTRI STATE MEDICAL CENTER PLLC
Location Address2398 5TH AVE STE 101Belle Fourche, SD 57717-2340
Mailing Address2398 5th Ave Ste 101Belle Fourche, SD 57717-2340 · (605) 645-2064
Phone(605) 645-2064
Organization SubpartNo
Authorized OfficialVanessa KudlockOwner · (605) 568-0191
Enumeration DateSeptember 13, 2023
Last NPPES UpdateJanuary 11, 2024
NPPES CertifiedJanuary 11, 2024
✔ NPI 1073390944 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
2398 5TH AVE STE 101, Belle Fourche, SD 57717
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Other Names 1

Former Legal Business NameTri State Medical Center Pllc

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Avera Health Plans.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Tri State Medical Center Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Tri State Medical Center PLLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Vanessa Kudlock, NP
Nurse Practitioner
NPI 1033752258
2398 5TH AVE STE 101
Belle Fourche, SD 57717
(605) 568-0191
✔ PECOS✔ Accepts MedicareSame address

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

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tri State Medical Center PLLC's NPI number?

The NPI number for Tri State Medical Center PLLC is 1073390944. It was assigned to this organization in the NPPES registry on September 13, 2023.

Where is Tri State Medical Center PLLC located?

Tri State Medical Center PLLC is located at 2398 5th Ave Ste 101, Belle Fourche, SD 57717. The listed phone number is (605) 645-2064.

What is Tri State Medical Center PLLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Tri State Medical Center PLLC enrolled in Medicare?

Yes. Tri State Medical Center PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Tri State Medical Center PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Tri State Medical Center PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Tri State Medical Center PLLC accept?

Health plans from Avera Health Plans list Tri State Medical Center PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Tri State Medical Center PLLC was last updated on January 11, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.