Mary S Carpenter, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

1484 Issued in SD

Practice address

809 Jackson St
Burke, SD 57523-2065

Phone

(605) 775-2631

Fax

(605) 775-2564

NPI assigned

Oct 18, 2006

Last updated

Sep 29, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Family Practice Associates of Winner Prof LLC

  • Family Medicine Physician
  • Winner, SD
  • NPI 1912083577
  NPD

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790640000000",
    "number": "1417038100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 JACKSON STREET",
            "address_2": "PO BOX 358",
            "city": "BURKE",
            "state": "SD",
            "postal_code": "57523",
            "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": "575232065",
            "telephone_number": "605-775-2631",
            "fax_number": "605-775-2564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARPENTER",
        "first_name": "MARY",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-18",
        "last_updated": "2026-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "1484",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5604133",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME",
            "identifier": "0851370001",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5604132",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5604130",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tony L Berg, MD
• Michael R Birgenheir, PAC
• Burke Ambulance Service Inc
• Burke Ambulance Service, Inc.
• Burke Community Pharmacy
• Community Memorial Hospital
• Community Memorial Hospital Inc
• Community Memorial Hospital, Inc
• Community Memorial Hospital, Inc (Burke Medical Clinic)
• Community Memorial Hospital, Inc

• Family Medicine Physician in Burke, SD
• Providers in Burke, SD by specialty
• Family Medicine Physician in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2026; 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.