TRI STATE MEDICAL CENTER PLLC
NPI 1073390944
Nurse Practitioner in Belle Fourche, SD
NPI Status: Active since September 13, 2023
Contact Information
2398 5TH AVE STE 101
BELLE FOURCHE, SD
ZIP 57717
Phone: (605) 645-2064
- Organization
- Nurse Practitioner
- Accepts Insurance
- CLIA Number: 43D2292092
- CLIA Cert. Type: Practitioner Other
- CLIA Exp. Date: 10-18-2027
About TRI STATE MEDICAL CENTER PLLC
This page provides the complete NPI Profile along with additional information for Tri State Medical Center Pllc, a provider established in Belle Fourche, South Dakota operating as a Nurse Practitioner. The healthcare provider is registered in the NPI registry with number 1073390944 assigned on September 2023. The practitioner's primary taxonomy code is 363L00000X. The provider is registered as an organization and their NPI record was last updated 2 years ago. The provider's former legal business name is Tri State Medical Center Pllc. The authorized official of this NPI record is Vanessa Kudlock Cnp (Owner)
- NPI
- 1073390944
- Provider Legal Name
- TRI STATE MEDICAL CENTER PLLC
- Other Organization Name
- TRI STATE MEDICAL CENTER PLLC
- Other Name Type
- Former Legal Business Name (4)
- Entity Type
- Organization
- Location Address
- 2398 5TH AVE STE 101 BELLE FOURCHE, SD 57717
- Location Phone
- (605) 645-2064
- Mailing Address
- 2398 5TH AVE STE 101 BELLE FOURCHE, SD 57717
- Mailing Phone
- (605) 645-2064
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 09-13-2023
- Last Update Date
- 01-11-2024
- Code Navigator
A nurse practitioner (NP) like Tri State Medical Center Pllc is an experienced registered nurse with a master’s or doctoral degree and advanced clinical training. Nurse practitioners can work in many different specialties including primary care, pediatrics, cardiology, emergency, women’s health, oncology or geriatrics. Nurse practitioners provide services like physical exams, order laboratory tests, manage diseases, write prescriptions, etc.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Nurse Practitioner
- Taxonomy Code
- 363L00000X
- Type
- Physician Assistants & Advanced Practice Nursing Providers
- Taxonomy Description
- (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.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- ConnectPlus $0 Gold - PPO
- ConnectPlus $0 Silver - PPO
- ConnectPlus $10,600 HSA Eligible HDHP - PPO
- ConnectPlus $1800 - PPO
- ConnectPlus $4500 - PPO
- ConnectPlus $6500 HSA Eligible HDHP - PPO
- ConnectPlus $7500 HSA Eligible HDHP - PPO
- ConnectPlus MyWeighForward $2000 - PPO
- ConnectPlus MyWeighForward $6000 - PPO
- ConnectPlus Standard $2000 - PPO
- ConnectPlus Standard $6000 - PPO
- ConnectPlus Standard $7500 HSA Eligible HDHP - PPO
- Medica Individual Choice Bronze $0 Copay PCP Visits - HMO
- Medica Individual Choice Bronze Share - HMO
- Medica Individual Choice Expanded Bronze Standard - HMO
- Medica Individual Choice Gold $0 Copay PCP Visits - HMO
- Medica Individual Choice Gold Share - HMO
- Medica Individual Choice Gold Standard - HMO
- Medica Individual Choice Silver $0 Copay PCP Visits - HMO
- Medica Individual Choice Silver Share - HMO
- Medica Individual Choice Silver Standard - HMO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 43D2292092
- Facility Type
- Practitioner Other
- Certificate Effective Date
- October 19, 2025
- Certificate Expiration Date
- October 18, 2027
- Laboratory Director
- VANESSA KUDLOCK
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Tri State Medical Center Pllc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1073390944, we treat the final digit (4) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 66. The final step is to find the difference between that total and the next multiple of ten (70 - 66 = 4).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 66 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 2 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1073390944, enumerated as an "organization" on September 13, 2023.
The provider is located at 2398 5TH AVE STE 101 BELLE FOURCHE, SD 57717 and the phone number is (605) 645-2064.
Nurse Practitioner with taxonomy code 363L00000X.
The provider might be accepting Accepts: Avera Health Plans and Medica. Please consult your insurance carrier or call the provider to verify.
