Pine Ridge Indian Health Service Hospital
Organization Active NPI Clinic/Center · Manderson, SD
NPI 1487701348 · NPPES record last updated Aug 4, 2020
Key facts
- NPI
- 1487701348
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- PINE RIDGE INDIAN HEALTH SERVICE HOSPITAL
- Practice address
- Downtown Manderson
Manderson, SD 57756 - Phone
- (605) 867-5431
- NPI assigned
- Jan 4, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- PINERIDGE INDIAN HEALTH SERVICE HOSPITAL
Authorized official
- Name
- Rhonda M Akers
- Title
- Health System Specialist
- Phone
- (605) 867-3032
Other NPIs on the same Medicare enrollment 4
Practitioners 54
-
Joyce Achenjang, M.D
-
Steven G Beliel, D.O.
-
Colleen Lorraine Campbell-Lane, PHD, LCSW, ACHP-SW
-
Monte Steven Dirks, M.D.
-
Suzanne Marie England, APRN, CNP
-
Christina Mae Ferguson, FNP-C
-
Renee Friend, MSW, LCSW
-
Brenda Mae Johnson, APRN
-
Tenecia Dawn Lancaster, FNP-BC
-
Jennifer Risse, CNP
-
Todd N Smith, DPM
-
Tricia L Uhlir, CNP
-
Susan J Walden, FNP-C
-
Shannon Wolfinbarger, CNM
-
Amanda Mytt Youngers, CNM
-
Lori Jane Barnes, DNP, GNPC
-
Cashana Monique Betterly, M.D.
-
Adam Borah, MD
-
Mary Theresa Chapman, FNP-BC
Affiliated clinicians 89
-
Shakeel Ahmed, MD
-
Denise Marie Baragar, CNP
-
Jean Cunningham, NP-C
-
Christina Mae Ferguson, FNP-C
-
Angelia Frederick, CNP
-
Amber Nicole Janis, PMHNP-BC
-
Carla Dale Krueger, FNP-C
-
Angela Loeffler, CNM
-
William John Miner, M.D.
-
Andrew Scott Qualm, O.D.
-
Louis C Raymond, MD
-
Jennifer Risse, CNP
-
Braj N Singh, MD
-
Tricia L Uhlir, CNP
-
Susan J Walden, FNP-C
-
Olumide Anthony Akinyemi, NURSE PRACTITIONER
-
Lisa Lowry Blake, CNM
-
Mary Theresa Chapman, FNP-BC
-
Breanna Connett, DO
Medicare Care Compare: Hospital
- Listed as
- Pine Ridge IHS Hospital
- Type
- Acute Care Hospitals
- Ownership
- Government - Federal
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, SD
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
- Other · Non-profit
- Enrollment address
- 607 Indian Health Rd
Pine Ridge, SD 57770-3169 - Hospital subgroups
- General
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Rhonda Akers |
5% Or Greater Indirect Ownership Interest | Sep 27, 2024 | |
| Corporate Director |
Jun 8, 2020 | ||
| W-2 Managing Employee |
Sep 27, 2024 | ||
| Operational/Managerial Control | Sep 27, 2024 | ||
| Brenda Badmilk |
Corporate Director |
Jun 8, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Part of
- Pine Ridge IHS Hospital Pharmacy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5549100 | Medicaid | SD |
Other names
- Manderson Field Clinic
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 4, 2020. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- 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.