Jennie A Brehm, PA
Individual provider Active NPI Physician Assistant · Fort Meade, SD
NPI 1477574176 · NPPES record last updated Mar 20, 2024
Key facts
- NPI
- 1477574176
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 1150 (SD)
- Practice address
- 113 Comanche Rd
Fort Meade, SD 57741-1002 - Phone
- (605) 347-2511
- NPI assigned
- Jul 21, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Black Hills Surgical Hospital LLC
Great Plains Tribal Chairmen'S Health Board
Practice addresses (Care Compare)
1730 Haines Ave
Rapid City, SD 57701-0615
Phone (605) 791-7788
216 Anamaria Dr
Rapid City, SD 57701-7366
Phone (605) 791-7777
3200 Canyon Lake Dr
Rapid City, SD 57702-8114
Phone 60535525002356
741 Mountain View Rd
Suite 1
Rapid City, SD 57702-2539
Phone (605) 791-7777
Hospital & facility affiliations
- Black Hills Surgical Hospital LLC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in SD, TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190702001800 | SD | Practitioner - Physician Assistant | 3173527173 | Reassigns benefits to 1 organization |
| I20221103000097 | TX | Practitioner - Physician Assistant | 3173527173 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1465 | CO | MD | Chiropractor |
| 962 | NE | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Black Hills Surgical Hospital, LLC | Current |
Accepting new patients | |
| Black Hills Surgical Hospital, LLC | Current | Accepting new patients | |
| Black Hills Surgical Hospital, LLC | Current |
Accepting new patients | |
| Stephen Tamang MD Consulting Schangervices PC | Past |
Accepting new patients |
Locations
216 Anamaria Dr
Rapid City, SD 57701
Phone (605) 388-9440
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1150 | SD | Yes |
Addresses
Primary practice location
113 Comanche Rd
Fort Meade, SD 57741-1002
Mailing address
2165 Promise Rd
Rapid City, SD 57701-8981
Phone (605) 718-1095
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1150 | Other | SD | SOUTH DAKOTA STATE LICENSE |
Other providers in Fort Meade, SD
- Brenda S Bonnichsen
- Lema Bordeaux
- Donna Maria Bossman
- Mayra Jeaneth Boyd
- Gayle Braun
- John Philip Breth
- Mitchell Brewer
- Melissa Brimmer
- Camarae Elizabeth Brink
- Wendy Brink
All providers in Fort Meade, SD · Physician Assistant in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.