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JENNIFER NOTEBOOM LPC
NPI 1215682133
Counselor - Professional in Wagner, SD

Active since February 18, 2022PECOS EnrolledAccepts Medicare Assignment
111 WASHINGTON AVE NW, WAGNER, SD 57380(605) 384-4861(605) 384-4872 Get Directions Write a Review

NPPES record last updated: February 18, 2022. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Jennifer Noteboom Lpc NPPES

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

JENNIFER NOTEBOOM LPC (NPI 1215682133) is an individual professional provider in Wagner, South Dakota, licensed in South Dakota (LPC20549) and active in the NPI registry since February 2022. She is enrolled in Medicare PECOS and is a graduate of Other (2000).

NPPES Registry Identity

NPI1215682133
Entity TypeIndividualFemale
Primary Taxonomy101YP2500X
Provider Legal NameJENNIFER NOTEBOOMCredential: LPC
Location Address111 WASHINGTON AVE NWWagner, SD 57380-4300
Mailing Address111 Washington Ave NwWagner, SD 57380-4300 · (605) 384-4861 · Fax (605) 384-4872
Phone(605) 384-4861
Fax(605) 384-4872
Sole ProprietorNo
Medical School CMSOtherGraduated 2000
Enumeration DateFebruary 18, 2022
NPPES CertifiedFebruary 18, 2022
✔ NPI 1215682133 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in SD · LPC20549
111 WASHINGTON AVE NW, Wagner, SD 57380
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jennifer Noteboom Lpc 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 ID2769829266
PECOS Enrollment IDI20240320000475
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 Jennifer Noteboom reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Wagner Indian Health Service Health Center
Same address
Clinic/Center
111 WASHINGTON AVE
Wagner, SD 57380
  • Reassigned Medicare billing, Texas enrollment
  • 21 clinicians in this Medicare group
NPI 1326066796 (605) 384-3621

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

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.

DIANA LYNN WACKEL RPH
Pharmacist
111 WASHINGTON AVE NW
WAGNER, SD 57380
Charles Mix County (605) 384-3621
JUDY CUKA
Registered Nurse (Community Health)
111 WASHINGTON AVE NW
WAGNER, SD 57380
Charles Mix County (605) 384-4804
SUSAN GRACE KNUDSEN RN
Registered Nurse
111 WASHINGTON AVE NW
WAGNER, SD 57380
Charles Mix County (605) 384-3621
VICKI LYNN THALER RN
Registered Nurse
111 WASHINGTON AVE NW
WAGNER, SD 57380
Charles Mix County (605) 384-3621
DR. RISHI PATEL M.D.
General Practice
111 WASHINGTON AVE NW
WAGNER, SD 57380
Charles Mix County (818) 743-3637
JOSHUA WOODS PHARMACIST
Pharmacist
111 WASHINGTON AVE NW
WAGNER, SD 57380
Charles Mix County (605) 384-3621
JOSEPH R SEES RPT
Physical Therapist
111 WASHINGTON AVE NW
WAGNER, SD 57380
Charles Mix County (605) 384-3621
MRS. PATRICIA ANN GOULETTE RN
Registered Nurse
111 WASHINGTON AVE NW
WAGNER, SD 57380
Charles Mix County (605) 384-3621

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 Jennifer Noteboom's NPI number?

The NPI number for Jennifer Noteboom is 1215682133. It was assigned to this individual provider in the NPPES registry on February 18, 2022.

Where is Jennifer Noteboom located?

Jennifer Noteboom practices at 111 Washington Ave NW, Wagner, SD 57380. The listed phone number is (605) 384-4861.

What is Jennifer Noteboom's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is Jennifer Noteboom enrolled in Medicare?

Yes. Jennifer Noteboom 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.

Which organization bills Medicare for Jennifer Noteboom's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jennifer Noteboom reassigns Medicare benefits to Wagner Indian Health Service Health Center (Wagner, SD). The 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 Jennifer Noteboom's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Jennifer Noteboom was last updated on February 18, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.