NPIMap

Organization Active NPI

City of Brookings

Doing business as Brookings Health System

  • Community Based Hospice Care Agency
  • Brookings, SD
National Provider Identifier
1306928494
Registry record updated Dec 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
CITY OF BROOKINGS
Doing business as
Brookings Health System
Practice address
300 22ND Ave
Brookings, SD 57006-2480
Phone
(605) 696-9000
Fax
(605) 696-7728
NPI assigned
Oct 19, 2006
Last updated
Dec 4, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2018

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

Authorized official

Name
Mrs. Melissa Wagner
Title
Cfo
Phone
(605) 696-9000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X NU Primary

Addresses

Primary practice location

300 22ND Ave
Brookings, SD 57006-2480

Mailing address

300 22ND Ave
Brookings, SD 57006-2480
Phone (605) 696-9000

Other identifiers 1

IdentifierTypeStateIssuer
0154120MedicaidSD

Other names 1

  • Brookings Health System Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120402000581 SD Part A Provider - Hospice 1052307105 Practice locations: Brookings, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306928494. Details of each certification follow.

Hospice certification: CCN 431509

Legal name
CITY OF BROOKINGS
Doing business as
BROOKINGS HEALTH SYSTEM
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jul 26, 1995
Last certification
Jul 13, 2022
Ownership / control type
Government - City
Organization structure
OtherNon-profit
Enrollment address
300 22ND Ave
Brookings, SD 57006-2480

Other NPIs with the same Medicare PAC ID 8

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Brookings Health SystemCCN 431509 · All quality measures
Ownership
Government
Certified
Jul 26, 1995
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Brookings Hospital Ma13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
City of Brookings Organization, Brookings, SD Other Jul 1, 1966 100%
Jason R Merkley Individual W-2 Managing EmployeeAd; Dec 5, 2011
Kelly M Evans-Hullinger Individual Contracted Managing EmployeeMD; Mar 17, 2020
Melissa Wagner Individual Corporate OfficerCfo Sep 15, 2018
W-2 Managing Employee Sep 15, 2018

Owners & managing parties with NPI records 9

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 7

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

FacilityTypeRoleSince
Brookings Health SystemBrookings, SD, CCN 430008 Hospital 5% Or Greater Direct Ownership Interest Jun 8, 2010
Brookings Health SystemBrookings, SD, CCN 43U008 Hospital 5% Or Greater Direct Ownership Interest Jun 8, 2010
Brookings Health System the Neighborhoods at BrookviewBrookings, SD, CCN 435083 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF		 Mar 21, 1970
Mar 21, 1970
Brookings Health SystemBrookings, SD, CCN 437030 Home health agency Other (100%) Nov 9, 2011
Brookings Health System Arlington Medical ClinicArlington, SD, CCN 433433 Rural health clinic 5% Or Greater Direct Ownership Interest May 1, 2010
Brookings Health System White Medical ClinicWhite, SD, CCN 433436 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Brookings Health System Volga Medical ClinicVolga, SD, CCN 433438 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2014

Owned or controlled facilities with NPI records 10

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

  • City of Brookings

    dba Avera Medical Group a Department of Brookings Health System

    • Multi-Specialty Clinic/Center
    • Brookings, SD
    • NPI 1134558158

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Brookings

    dba Brookings Health System

    • General Acute Care Hospital
    • Brookings, SD
    • NPI 1275515579

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Brookings

    dba Brookings Health System

    • Skilled Nursing Facility
    • Brookings, SD
    • NPI 1417039504

    5% Or Greater Direct Ownership Interest, Adp of the SNF

    CMS ownership
  • City of Brookings
    • Rural Health Clinic/Center
    • Volga, SD
    • NPI 1811318074

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Brookings

    dba Brookings Health System

    • Home Health Agency
    • Brookings, SD
    • NPI 1861574956

    Other

    CMS ownership
  • City of Brookings

    dba Brookings Health System Arlington Medical Center

    • Rural Health Clinic/Center
    • Arlington, SD
    • NPI 1902123581

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Brookings

    dba Brookings Health System White Clinic

    • Rural Health Clinic/Center
    • White, SD
    • NPI 1912279829

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Brookings

    dba Brookings Health System

    • Anesthesiology Physician
    • Brookings, SD
    • NPI 1932281029

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Brookings

    dba Brookings Health System

    • Medicare Defined Swing Bed Hospital Unit
    • Brookings, SD
    • NPI 1962584052

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Brookings

    dba Avera Medical Group Specialty Care Brookings a Department of Brookings

    • Multi-Specialty Clinic/Center
    • Brookings, SD
    • NPI 1982057246

    5% Or Greater Direct Ownership Interest

    CMS ownership

Practitioners & affiliated clinicians

Affiliated clinicians 8

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": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543881600000",
    "number": "1306928494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 22ND AVE",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "570062480",
            "telephone_number": "605-696-9000",
            "fax_number": "605-696-7728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 22ND AVE",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "570062480",
            "telephone_number": "605-696-9000",
            "fax_number": "605-696-7728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF BROOKINGS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2018-12-04",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "605-696-9000",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0154120",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookings Health System",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Brookings Health System",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brookings, SD

Sources for this page

Verify at the official NPI Registry.