NPIMap

Community Memorial Hospital Inc

Organization Active NPI Rural Health Clinic/Center · Bonesteel, SD

NPI 1033147384 · NPPES record last updated Aug 25, 2025

Key facts

NPI
1033147384
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
COMMUNITY MEMORIAL HOSPITAL INC
Practice address
314 Mellette Street
Bonesteel, SD 57317-0342
Phone
(605) 654-9021
NPI assigned
Jun 28, 2006
Organization subpart
No

Authorized official

Name
Mistie Drey II
Title
Ceo
Phone
(605) 775-2621

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Facilities connected through Provider of Services related, parent or unit certification numbers.

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in SD

Rural health clinic certification: CCN 433422

Legal name
COMMUNITY MEMORIAL HOSPITAL INC
Doing business as
BONESTEEL MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 9, 2004
Last certification
Jun 6, 2018
Ownership / control type
2B
Organization structure
Corporation · Non-profit
Incorporated
Apr 24, 1945 in SD
Enrollment address
314 Mellette St
Bonesteel, SD 57317-2110
Related CCNs
431309

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Mistie R Drey
Individual 		Corporate Director
Ceo		 Sep 13, 2015
W-2 Managing Employee
Ceo		 Jul 13, 2015
Douglas Spitzenberger
Individual 		Corporate Director
Director		 Jul 1, 2020
Jason Mosterd
Individual 		Corporate Director
Director		 Jul 1, 2021
Larry Shepperd
Individual 		Corporate Director
Director		 Jul 1, 2022
Dillon Lambley
Individual 		Corporate Director
Director		 Jul 1, 2023
Karen Martin
Individual 		Corporate Director
Director		 Apr 1, 2007
Rachelle Norberg
Individual 		Corporate Director
Secretary		 Jul 1, 2020
Clayton Steele
Individual 		Corporate Director
Director		 Apr 1, 2011
Michael Karbo
Individual 		Corporate Director
Chairman		 Apr 1, 2006
Rebecca Jones
Individual 		Corporate Director
Director		 Apr 1, 2018

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040519000690 SD Part a Provider - Rural Health Clinic 2163317900 Practice locations: Bonesteel, SD

National Provider Directory

Locations

210 Broadway St
Butte, NE 68722
Phone (402) 775-2355

314 Mellette St
Bonesteel, SD 57317
Phone (605) 654-9021

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X SD Yes

Addresses

Primary practice location

314 Mellette Street
Bonesteel, SD 57317-0342

Mailing address

314 Mellette Street
Bonesteel, SD 57317-0342
Phone (605) 654-9021

Other identifiers

IdentifierTypeStateIssuer
5340240MedicaidSD

Other names

  • BONESTEEL MEDICAL CLINIC Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 25, 2025.

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756080000000",
    "number": "1033147384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 MELLETTE STREET",
            "city": "BONESTEEL",
            "state": "SD",
            "postal_code": "573170342",
            "telephone_number": "605-654-9021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 MELLETTE STREET",
            "city": "BONESTEEL",
            "state": "SD",
            "postal_code": "573170342",
            "telephone_number": "605-654-9021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEMORIAL HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-28",
        "last_updated": "2025-08-25",
        "certification_date": "2025-08-25",
        "status": "A",
        "authorized_official_last_name": "DREY",
        "authorized_official_first_name": "MISTIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "605-775-2621",
        "authorized_official_name_suffix": "II"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "SD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5340240",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BONESTEEL MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BONESTEEL MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bonesteel, SD

All providers in Bonesteel, SD · Rural Health Clinic/Center in South Dakota

Sources for this page

Verify at the official NPI Registry.