NPIMap

Organization Active NPI

Douglas County Memorial Hospital

Doing business as Prairie Health Clinic

  • Clinic/Center
  • Armour, SD
National Provider Identifier
1174516124
Registry record updated Oct 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
DOUGLAS COUNTY MEMORIAL HOSPITAL
Doing business as
Prairie Health Clinic
Practice address
708 8TH St
Armour, SD 57313-2102
Phone
(605) 724-2151
Fax
(605) 724-2310
NPI assigned
Aug 25, 2005
Last updated
Oct 19, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2007

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

Authorized official

Name
Nicole J Neugebauer, CPC
Title
Clinic Office Manager
Phone
(605) 724-2151

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

708 8TH St
Armour, SD 57313-2102

Mailing address

708 8TH St
Armour, SD 57313-2102
Phone (605) 724-2151

Other identifiers 1

IdentifierTypeStateIssuer
5300600MedicaidSD

Other names 1

  • Prairie Health Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041029000768 SD Part A Provider - Rural Health Clinic 7810889771 Practice locations: Armour, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174516124. Details of each certification follow.

Rural health clinic certification: CCN 433402

Legal name
DOUGLAS COUNTY MEMORIAL HOSPITAL
Doing business as
PRAIRIE HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 9, 1998
Last certification
Oct 25, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Dec 21, 1987 in SD
Enrollment address
708 8TH St
Armour, SD 57313-2102
Related CCNs
431305

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

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Prairie Health Clinic11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

1311 Braddock Ave
Armour, SD 57313
Phone (605) 724-2970

230 E Main St
Corsica, SD 57328
Phone (605) 946-5549

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Scott Holbeck Individual Corporate Director Jan 1, 2018
Heath Robert Brouwer Individual Corporate OfficerCeo May 10, 1999
W-2 Managing Employee May 10, 1999
Operational/Managerial Control May 10, 1999
Joel Dean Baier Individual Corporate Director Jan 1, 2018
Brad Vandenberg Individual Corporate Director Jun 1, 2011
Joann Schrank Individual Corporate Director Jan 1, 2009
Janet Lefers Individual Corporate Director Apr 22, 2020

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Prairie Health Clinic StickneyStickney, SD, CCN 433425 Rural health clinic Operational/Managerial Control Apr 1, 2006

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1124928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192752000000",
    "number": "1174516124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "708 8TH ST",
            "city": "ARMOUR",
            "state": "SD",
            "postal_code": "573132102",
            "telephone_number": "605-724-2151",
            "fax_number": "605-724-2310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 8TH ST",
            "city": "ARMOUR",
            "state": "SD",
            "postal_code": "573132102",
            "telephone_number": "605-724-2151",
            "fax_number": "605-724-2310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOUGLAS COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-25",
        "last_updated": "2007-10-19",
        "status": "A",
        "authorized_official_last_name": "NEUGEBAUER",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CLINIC OFFICE MANAGER",
        "authorized_official_telephone_number": "605-724-2151",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5300600",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prairie Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Armour, SD

Sources for this page

Verify at the official NPI Registry.