NPIMap

Individual provider Active NPI

Jill D Kruse, DO

  • Family Medicine Physician
  • Brooking, SD
National Provider Identifier
1114967403
Registry record updated Apr 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
7282 Issued in SD
Practice address
400 22ND Ave
Brooking, SD 57006-2450
Phone
(605) 697-9500
Fax
(605) 697-6939
NPI assigned
Jun 7, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 49795-021 WI
Family Medicine Physician 207Q00000X 7282 SD Primary

Addresses

Primary practice location

400 22ND Ave
Brooking, SD 57006-2450

Mailing address

400 22ND Ave
Brooking, SD 57006-2450
Phone (605) 697-9500

Other identifiers 1

IdentifierTypeStateIssuer
5613110MedicaidSD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081014000157 SD Practitioner - Family Practice 4486722725 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
City of BrookingsGroup PAC ID 1052307105, 112 clinicians

Practice addresses (Care Compare)

400 22ND Ave
Brookings, SD 57006-2447
Phone (605) 697-9500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
7282SDMDFamily Medicine Physician
49795-021WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rural Health Care, Inc CurrentSince Nov 1, 2020 Accepting new patients
City of Brookings Current Accepting new patients
City of Brookings CurrentSince Jan 1, 2014 Accepting new patients
Rural Health Care, Inc. Current Accepting new patients
City of Brookings CurrentSince Jan 1, 2014 Accepting new patients
Rural Health Care, Inc CurrentSince Nov 1, 2020 Accepting new patients
City of Brookings Past Accepting new patients

Locations

400 22nd Ave
Ste 1
Brookings, SD 57006
Phone (605) 697-9500

400 22nd Ave
Brookings, SD 57006
Phone (605) 692-6236

300 22nd Ave
Brookings, SD 57006
Phone (605) 692-6351

Interoperability endpoints

  • Direct secure messaging: jill.kruse@avera.sdhealthlink.net

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 30

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617235200000",
    "number": "1114967403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 22ND AVE",
            "city": "BROOKING",
            "state": "SD",
            "postal_code": "570062450",
            "telephone_number": "605-697-9500",
            "fax_number": "605-697-6939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 22ND AVE",
            "city": "BROOKING",
            "state": "SD",
            "postal_code": "570062450",
            "telephone_number": "605-697-9500",
            "fax_number": "605-697-6939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUSE",
        "first_name": "JILL",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-07",
        "last_updated": "2021-04-01",
        "certification_date": "2021-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "49795-021",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "7282",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5613110",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Sources for this page

Verify at the official NPI Registry.