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DR. JUSTIN A CLEM M.D.
NPI 1083050827
Family Medicine in Madison, SD

Active since May 20, 2013PECOS EnrolledAccepts Medicare Assignment
90.18/100
CMS Quality Rating
323 10TH ST SW, MADISON, SD 57042(605) 256-6551(605) 255-6409 Get Directions Write a Review

NPPES record last updated: November 8, 2016. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Nov 8, 2016, Sep 21, 2016 (2 updates tracked since 2016).

About Dr. Justin A Clem M.d. NPPES

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

DR. JUSTIN A CLEM M.D. (NPI 1083050827) is an individual family medicine provider in Madison, South Dakota, licensed in South Dakota (9998) and active in the NPI registry since May 2013. He is enrolled in Medicare PECOS, is affiliated with Avera Mckennan Hospital & University Health Center, and is a graduate of Other (2013).

NPPES Registry Identity

NPI1083050827
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameDR. JUSTIN A CLEMCredential: M.D.
Location Address323 10TH ST SWMadison, SD 57042-3200
Mailing Address323 10th St SwMadison, SD 57042-3200 · (605) 256-6551 · Fax (605) 255-6409
Phone(605) 256-6551
Fax(605) 255-6409
Sole ProprietorNo
Medical School CMSOtherGraduated 2013
Enumeration DateMay 20, 2013
Last NPPES UpdateNovember 8, 20162 updates tracked since enumeration
✔ NPI 1083050827 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in SD · 9998
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
323 10TH ST SW, Madison, SD 57042
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Medica, Sanford Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Justin A Clem M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7719116086
PECOS Enrollment IDI20160926001921
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.

Areas of Expertise CMS Part B claims 6

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes 99309
A follow-up nursing facility visit per day is a daily check-in by a healthcare professional. This 25-minute visit typically involves monitoring your health progress, addressing any concerns, and adjusting treatment plans as necessary. It's a vital part of ensuring your ongoing wellbeing.
152 services42 patients
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232
Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.
143 services63 patients
Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more 99308
A follow-up nursing facility visit per day is a daily check-up service provided by healthcare professionals. It lasts around 15 minutes and involves assessing your health status, monitoring your recovery progress, and addressing any concerns you may have about your health or treatment.
92 services40 patients
Hospital discharge day management, more than 30 minutes 99239
Hospital discharge day management over 30 minutes involves a detailed process to ensure a smooth transition from hospital to home. It includes final examinations, discussion of your hospital stay, post-discharge instructions, and coordinating follow-up care.
74 services60 patients
Nursing facility discharge management, more than 30 minutes 99316
Nursing facility discharge management over 30 minutes is a comprehensive process where a healthcare team prepares you for leaving the facility. It involves creating a tailored plan, coordinating care, and ensuring a smooth transition to your next care setting.
42 services35 patients
Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes 99305
An initial nursing facility visit per day is a service where a healthcare professional spends about 35 minutes assessing a patient's health status. This includes reviewing medical history, conducting a physical exam, and developing a care plan based on the patient's needs.
19 services17 patients

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Avera Mckennan Hospital & University Health Center

Acute Care Hospitals · Sioux Falls, SD
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number430016
Location1325 S Cliff AveSioux Falls, SD 57117 · Minnehaha County
Emergency services Birthing friendly

Sanford Usd Medical Center

Acute Care Hospitals · Sioux Falls, SD
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number430027
Location1305 W 18th St Post Office Box 5039Sioux Falls, SD 57117 · Minnehaha County
Emergency services Birthing friendly

Madison Regional Health System

Critical Access Hospitals · Madison, SD
OwnershipVoluntary non-profit - Private
CMS Certification Number431300
Location323 SW 10th StMadison, SD 57042 · Lake County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 57042 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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

90.18/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality86.69
Improvement Activities40
Cost91.67

Referred Medical Equipment & Supplies CMS DME claims 14

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
2 suppliers31 claims55 services$5.49 avg. paid by Medicare
Tubing with integrated heating element for use with positive airway pressure device A4604
DME-Other DME · category DE001N
3 suppliers11 claims11 services$43.45 avg. paid by Medicare
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431
DME-Oxygen and Supplies · category DC000N
2 suppliers27 claims29 services$20.51 avg. paid by Medicare
Humidifier, heated, used with positive airway pressure device E0562
DME-Other DME · category DE001N
1 supplier13 claims13 services$16.04 avg. paid by Medicare
Nebulizer, with compressor E0570
DME-Other DME · category DE000N
1 supplier12 claims12 services$6.54 avg. paid by Medicare
Continuous positive airway pressure (cpap) device E0601
DME-Other DME · category DE001N
1 supplier21 claims21 services$45.18 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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 Justin Clem's NPI number?

The NPI number for Justin Clem is 1083050827. It was assigned to this individual provider in the NPPES registry on May 20, 2013.

Where is Justin Clem located?

Justin Clem practices at 323 10th St SW, Madison, SD 57042. The listed phone number is (605) 256-6551.

What is Justin Clem's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Justin Clem enrolled in Medicare?

Yes. Justin Clem is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Justin Clem accept?

Health plans from Medica and Sanford Health Plan list Justin Clem 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.

Is Justin Clem affiliated with any hospitals?

According to CMS data, Justin Clem is affiliated with Avera Mckennan Hospital & University Health Center, Sanford Usd Medical Center and Madison Regional Health System.

When was this NPI record last updated?

The NPPES record for Justin Clem was last updated on November 8, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.