NPIMap

Organization Active NPI

Pine Ridge Indian Health Service Hospital

Doing business as LaCreek District Clinic

  • Clinic/Center
  • Martin, SD
National Provider Identifier
1003208257
Registry record updated Jul 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL
Doing business as
LaCreek District Clinic
Practice address
119 South 1St Avenue
Martin, SD 57551
Phone
(605) 685-2800
NPI assigned
Feb 25, 2015
Last updated
Jul 31, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
PINE RIDGE INDIAN HEALTH SERVICE HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 31, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Rhonda M Akers
Title
Health System Specialist
Phone
(605) 867-3032

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary
Federal Public Health Clinic/Center 261QP0904X

Addresses

Primary practice location

119 South 1St Avenue
Martin, SD 57551

Mailing address

119 South 1St Avenue
Martin, SD 57551
Phone (605) 685-2800

Other identifiers 2

IdentifierTypeStateIssuer
5949000MedicaidSD
430098OtherCCN

Other names 1

  • LaCreek District Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, SD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031218000966 TX Part B Supplier - Clinic/Group Practice 4688571326 Receives reassigned benefits from 478 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Manderson, SD; Martin, SD; Pine Ridge, SD; Allen, SD
O20200804002689 SD Part A Provider - Hospital 4688571326 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kyle, SD; Martin, SD; Pine Ridge, SD; Wanblee, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003208257. Details of each certification follow.

Hospital certification: CCN 430098

Legal name
PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL
Doing business as
PINE RIDGE IHS HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jun 8, 2020
Last certification
Jun 9, 2020
Beds
45
Ownership / control type
Federal
Organization structure
OtherNon-profit
Enrollment address
607 Indian Health Rd
Pine Ridge, SD 57770-3169
Main/Primary Hospital Location
Hospital subgroups
General

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Pine Ridge IHS HospitalCCN 430098 · All quality measures
Type
Acute Care Hospitals
Ownership
Government - Federal
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Part of
Pine RDG Indian HLTH SVC

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Rhonda Akers Individual 5% Or Greater Indirect Ownership Interest Sep 27, 2024
Corporate DirectorHealth System Specialist Jun 8, 2020
W-2 Managing EmployeeAd; Sep 27, 2024
Operational/Managerial Control Sep 27, 2024
Brenda Badmilk Individual Corporate DirectorHealth System Specialist Jun 8, 2020

Practitioners & affiliated clinicians

Practitioners 483

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 483

Affiliated clinicians 89

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 89

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1424822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596153600000",
    "number": "1003208257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 SOUTH 1ST AVENUE",
            "city": "MARTIN",
            "state": "SD",
            "postal_code": "57551",
            "telephone_number": "605-685-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 SOUTH 1ST AVENUE",
            "city": "MARTIN",
            "state": "SD",
            "postal_code": "57551",
            "telephone_number": "605-685-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL",
        "enumeration_date": "2015-02-25",
        "last_updated": "2020-07-31",
        "certification_date": "2020-07-31",
        "status": "A",
        "authorized_official_last_name": "AKERS",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "HEALTH SYSTEM SPECIALIST",
        "authorized_official_telephone_number": "605-867-3032"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP0904X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, Federal",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5949000",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CCN",
            "identifier": "430098",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LaCreek District Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LaCreek District Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Martin, SD

Sources for this page

Verify at the official NPI Registry.