NPIMap

Organization Active NPI

Community Memorial Hospital, Inc

  • Critical Access Hospital
  • Burke, SD
National Provider Identifier
1124108568
Registry record updated Oct 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
10530 Issued in SD
Legal business name
COMMUNITY MEMORIAL HOSPITAL, INC
Practice address
809 Jackson St
Burke, SD 57523-0319
Phone
(605) 775-2631
Fax
(605) 775-2564
NPI assigned
Oct 17, 2006
Last updated
Oct 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2022

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

Authorized official

Name
Mistie Drey
Title
Credentialing
Phone
(605) 775-2621

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 10530 SD Primary

Addresses

Primary practice location

809 Jackson St
Burke, SD 57523-0319

Mailing address

809 Jackson St
PO Box 319
Burke, SD 57523-0319
Phone (605) 775-2631

Other identifiers 1

IdentifierTypeStateIssuer
0159290MedicaidSD

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lynne.bentz@cmhburke.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080415000689 SD Part A Provider - Critical Access Hospital 2163317900 Receives reassigned benefits from 1 practitioner
Practice locations: Burke, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124108568. Details of each certification follow.

Hospital certification: CCN 43Z309

Legal name
COMMUNITY MEMORIAL HOSPITAL INC
Organization structure
CorporationNon-profit
Incorporated
Apr 24, 1945 in SD
Enrollment address
809 Jackson Street
Burke, SD 57523-0319
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Community Memorial Hospita5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Lynne Bentz Individual W-2 Managing EmployeeBilling Dec 13, 2017
Mistie R Drey Individual Corporate DirectorCeo Sep 18, 2015
W-2 Managing EmployeeCeo Sep 18, 2015
Douglas Spitzenberger Individual Corporate DirectorBoard Member Apr 1, 2019
Jason Mosterd Individual Corporate DirectorBoard Member Jul 1, 2021
Larry Shepperd Individual Corporate DirectorBoard Member Jul 1, 2022
Dillon Lambley Individual Corporate DirectorBoard Member Jul 1, 2023
Karen Martin Individual Corporate DirectorBoard Member Nov 16, 2007
Rachelle Norberg Individual Corporate DirectorSecretary Apr 1, 2019
Clayton Steele Individual Corporate DirectorBoard Member Apr 1, 2011
Michael Karbo Individual Corporate DirectorChairman Nov 16, 2007
Rebecca Jones Individual Corporate DirectorBoard Member Apr 1, 2018

Practitioners & affiliated clinicians

Practitioners 1

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.

Affiliated clinicians 4

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

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666656000000",
    "number": "1124108568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 JACKSON ST",
            "address_2": "PO BOX 319",
            "city": "BURKE",
            "state": "SD",
            "postal_code": "575230319",
            "telephone_number": "605-775-2631",
            "fax_number": "605-775-2564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 JACKSON ST",
            "city": "BURKE",
            "state": "SD",
            "postal_code": "575230319",
            "telephone_number": "605-775-2631",
            "fax_number": "605-775-2564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEMORIAL HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-25",
        "status": "A",
        "authorized_official_last_name": "DREY",
        "authorized_official_first_name": "MISTIE",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "605-775-2621"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "SD",
            "license": "10530",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0159290",
            "state": "SD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lynne.bentz@cmhburke.org",
            "affiliation": "N",
            "address_1": "809 JACKSON ST",
            "city": "BURKE",
            "state": "SD",
            "country_code": "US",
            "postal_code": "575230319",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Burke, SD

Sources for this page

Verify at the official NPI Registry.