NPIMap

Organization Active NPI

Pine Ridge Indian Health Service Hospital

Doing business as Manderson Field Clinic

  • Clinic/Center
  • Manderson, SD
National Provider Identifier
1487701348
Registry record updated Aug 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL
Doing business as
Manderson Field Clinic
Practice address
Downtown Manderson
Manderson, SD 57756
Phone
(605) 867-5431
NPI assigned
Jan 4, 2007
Last updated
Aug 4, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
PINERIDGE INDIAN HEALTH SERVICE HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 4, 2020

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

Authorized official

Name
Rhonda M Akers
Title
Health System Specialist
Phone
(605) 867-3032

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

Downtown Manderson
Manderson, SD 57756

Mailing address

P.O. Box 1201
Pine Ridge, SD 57770-1201
Phone (605) 867-5131

Other identifiers 1

IdentifierTypeStateIssuer
5549100MedicaidSD

Other names 1

  • Manderson Field Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, SD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031218000966 TX Part B Supplier - Clinic/Group Practice 4688571326 Receives reassigned benefits from 478 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Manderson, SD; Martin, SD; Pine Ridge, SD; Allen, SD
O20200804002689 SD Part A Provider - Hospital 4688571326 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kyle, SD; Martin, SD; Pine Ridge, SD; Wanblee, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487701348. Details of each certification follow.

Hospital certification: CCN 430098

Legal name
PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL
Doing business as
PINE RIDGE IHS HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jun 8, 2020
Last certification
Jun 9, 2020
Beds
45
Ownership / control type
Federal
Organization structure
OtherNon-profit
Enrollment address
607 Indian Health Rd
Pine Ridge, SD 57770-3169
Main/Primary Hospital Location
Hospital subgroups
General

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Pine Ridge IHS HospitalCCN 430098 · All quality measures
Type
Acute Care Hospitals
Ownership
Government - Federal
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Part of
Pine Ridge IHS Hospital

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Rhonda Akers Individual 5% Or Greater Indirect Ownership Interest Sep 27, 2024
Corporate DirectorHealth System Specialist Jun 8, 2020
W-2 Managing EmployeeAd; Sep 27, 2024
Operational/Managerial Control Sep 27, 2024
Brenda Badmilk Individual Corporate DirectorHealth System Specialist Jun 8, 2020

Practitioners & affiliated clinicians

Practitioners 60

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 60

Affiliated clinicians 89

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 89

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596499200000",
    "number": "1487701348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 1201",
            "city": "PINE RIDGE",
            "state": "SD",
            "postal_code": "577701201",
            "telephone_number": "605-867-5131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "DOWNTOWN MANDERSON",
            "city": "MANDERSON",
            "state": "SD",
            "postal_code": "57756",
            "telephone_number": "605-867-5431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PINERIDGE INDIAN HEALTH SERVICE HOSPITAL",
        "enumeration_date": "2007-01-04",
        "last_updated": "2020-08-04",
        "certification_date": "2020-08-04",
        "status": "A",
        "authorized_official_last_name": "AKERS",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "HEALTH SYSTEM SPECIALIST",
        "authorized_official_telephone_number": "605-867-3032"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5549100",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Manderson Field Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Sources for this page

Verify at the official NPI Registry.