Pine Ridge Indian Health Service Hospital

Primary specialty

Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X

Legal business name

PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL

Practice address

210 1St St
Wanblee, SD 57577

Phone

(605) 462-6155

Fax

(605) 462-6551

NPI assigned

Mar 6, 2007

Organization subpart

Yes

Parent organization

PINE RIDGE INDIAN HEALTH SERVICE HOSPITALAs reported in NPPES

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

Authorized official

Name

James Cummings, PHARMD

Title

Pharmacy Program Specialist

Phone

(405) 951-6086

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Wanblee Health Center Doing business as

Part of

Pine Ridge IHS Hospital Pharmacy

Locations

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606262400000",
    "number": "1174653752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3120 SOLUTIONS CTR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606773001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 1ST ST",
            "city": "WANBLEE",
            "state": "SD",
            "postal_code": "57577",
            "telephone_number": "605-462-6155",
            "fax_number": "605-462-6551"
        }
    ],
    "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": "2007-03-06",
        "last_updated": "2020-11-25",
        "certification_date": "2020-11-24",
        "status": "A",
        "authorized_official_last_name": "CUMMINGS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "PHARMACY PROGRAM SPECIALIST",
        "authorized_official_telephone_number": "405-951-6086",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5540040",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "4304907",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wanblee Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wanblee Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dwan Renee Kendrick, RN
• Denise Kovach
• Anita Marie Masaitis, DMD
• Jaimee Allisen McGuire, DNP, RN, NP-C
• Pine Ridge Indian Health Service
• Pine Ridge Indian Health Service Hospital
• Cindy Lou Rheault, RPH
• George Edward Starr, PAC

• All providers in Wanblee, SD
• Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.