NPIMap

Individual provider Active NPI

Kenric D Malmberg, MD

  • Family Medicine Physician
  • Brookings, SD
National Provider Identifier
1376585885
Registry record updated Jun 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
7340A Issued in WY
Practice address
400 22ND Ave
Brookings, SD 57006-2497
Phone
(605) 697-9500
Fax
(605) 697-6939
NPI assigned
Jun 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 7340A WY Primary

Addresses

Primary practice location

400 22ND Ave
Brookings, SD 57006-2497

Mailing address

400 22ND Ave
Brookings, SD 57006-2497
Phone (605) 697-9500

Other identifiers 2

IdentifierTypeStateIssuer
5612920MedicaidSD
4992950OtherSDBLUE SHIELD

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
I20070808000757 SD Practitioner - Family PracticePractitioner - Obstetrics/Gynecology 4981795796 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Obstetrics/Gynecology
Education
University of North Dakota School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
City of BrookingsGroup PAC ID 1052307105, 112 clinicians
Rural Health Care IncGroup PAC ID 3476447541, 156 clinicians

Practice addresses (Care Compare)

300 22ND Ave
Brookings, SD 57006-2480
Phone (605) 692-6351

300 22ND Ave
Brookings, SD 57006-2496

310 22ND Ave
Brookings, SD 57006-2474
Phone (605) 697-9500

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

Hospital & facility affiliations

  • Brookings Health System Home health agency, Brookings, SD, CCN 437030
  • Aseracare Hospice Hospice, Sioux Falls, SD, CCN 431516
  • Brookings Health System Hospice, Brookings, SD, CCN 431509
  • Brookings Health System Hospital, Brookings, SD, CCN 430008
  • United Living Community Nursing home, Brookings, SD, CCN 435079
  • The Neighborhoods at Brookview Nursing home, Brookings, SD, CCN 435083

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
7059SDMDPharmacist
7340AWYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rural Health Care, Inc CurrentSince Nov 1, 2020 Accepting new patients
Rural Health Care, Inc CurrentSince Nov 1, 2020 Accepting new patients
City of Brookings CurrentSince Jul 1, 2014 Accepting new patients
Rural Health Care, Inc. Current Accepting new patients
United Retirement Center Past Accepting new patients
Mobridge Regional Hospital Family Medicine Past 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: kenric.malmberg@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 and National Provider Directory roles.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403740800000",
    "number": "1376585885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 22ND AVE",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "570062497",
            "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": "BROOKINGS",
            "state": "SD",
            "postal_code": "570062497",
            "telephone_number": "605-697-9500",
            "fax_number": "605-697-6939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALMBERG",
        "first_name": "KENRIC",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-11",
        "last_updated": "2014-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WY",
            "license": "7340A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5612920",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "4992950",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookings, SD

Sources for this page

Verify at the official NPI Registry.