28th Medgrp-Ellsworth
28th Medgrp-Ellsworth is a healthcare organization registered as Military/U.S. Coast Guard Outpatient Clinic/Center in Ellsworth Afb, SD, holding Type 2 (organization) NPI 1023091642 since 2005. The authorized official on file is Jen Lewandowski, Dha Ubo.
✓ Active NPI ✓ Valid NPI checksum Organization subpart
| NPI | 1023091642 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | 28th Medgrp-Ellsworth |
| Other name | <Unavail> |
| Parent organization | 28th Medgrp-Ellsworth |
| Practice address | 2900 DOOLITTLE DR, Ellsworth Afb, SD, 57706 |
| Phone | 6053853311 |
| Fax | 6053853234 |
| Enumeration date | 2005-11-29 |
| Last updated in NPPES | 2025-06-17 |
Authorized official
| Name | Jen Lewandowski |
|---|---|
| Title | Dha Ubo |
| Phone | 7038174030 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 261QM1101X | Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center | Secondary | — | — |
| 332000000X | Military/U.S. Coast Guard Pharmacy | Secondary | — | — |
| 261QM1100X | Military/U.S. Coast Guard Outpatient Clinic/Center | Primary | — | — |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4304969 | Other | SD | NCPDP |
| 5351000 | Medicaid | SD | — |
Copy-ready billing details
Provider: 28th Medgrp-Ellsworth NPI: 1023091642 Taxonomy: 261QM1100X (Military/U.S. Coast Guard Outpatient Clinic/Center) Address: 2900 DOOLITTLE DR, Ellsworth Afb, SD, 57706
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1346233327 | Christopher Rohde | Individual | Aerospace Medicine Physician | Ellsworth Afb, SD |
| 1083607535 | Michael Bogaard | Individual | Optometrist | Ellsworth Afb, SD |
| 1124009956 | Benjamin Coon | Individual | General Practice Dentistry | Ellsworth Afb, SD |
| 1164492534 | Betty Smith | Individual | Physical Therapist | Ellsworth Afb, SD |
| 1841263977 | Randy Oliver | Individual | Optometrist | Ellsworth Afb, SD |
| 1154394278 | Kelvin Krause | Individual | General Practice Dentistry | Ellsworth Afb, SD |
| 1649243486 | Randy Guliuzza | Individual | Aerospace Medicine Physician | Ellsworth Afb, SD |
| 1831163468 | Robin Johnson | Individual | Pharmacist | Ellsworth Afb, SD |
Verify this record
Cross-check NPI 1023091642 against the authoritative CMS record: view 28th Medgrp-Ellsworth on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
What is the NPI number for 28th Medgrp-Ellsworth?
Who is the authorized official for 28th Medgrp-Ellsworth?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2025-06-17.