NPIMap

Organization Active NPI

Community Memorial Hospital Inc

  • Critical Access Hospital Clinic/Center
  • Burke, SD
National Provider Identifier
1487878435
Registry record updated Oct 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access Hospital Clinic/CenterTaxonomy code 261QC0050X
License
10530 Issued in SD
Legal business name
COMMUNITY MEMORIAL HOSPITAL INC
Practice address
809 Jackson St
Burke, SD 57523-0319
Phone
(605) 775-2621
NPI assigned
Apr 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2022

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

Authorized official

Name
Mistie Sachtjen
Title
Ceo
Phone
(605) 775-2621

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital Clinic/Center 261QC0050X 10530 SD Primary

Addresses

Primary practice location

809 Jackson St
Burke, SD 57523-0319

Mailing address

809 Jackson St
Burke, SD 57523-0319
Phone (605) 775-2621

Other identifiers 2

IdentifierTypeStateIssuer
5340240MedicaidSD
5306722MedicaidSD

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lynne.bentz@cmhburke.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040219000507 SD Part B Supplier - Clinic/Group Practice 2163317900 Receives reassigned benefits from 15 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bonesteel, SD; Burke, SD

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Community Memorial Hospital5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666656000000",
    "number": "1487878435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 JACKSON ST",
            "city": "BURKE",
            "state": "SD",
            "postal_code": "575230319",
            "telephone_number": "605-775-2621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 JACKSON ST",
            "city": "BURKE",
            "state": "SD",
            "postal_code": "575230319",
            "telephone_number": "605-775-2621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEMORIAL HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-25",
        "status": "A",
        "authorized_official_last_name": "SACHTJEN",
        "authorized_official_first_name": "MISTIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "605-775-2621"
    },
    "taxonomies": [
        {
            "code": "261QC0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Critical Access Hospital",
            "state": "SD",
            "license": "10530",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5340240",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5306722",
            "state": "SD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lynne.bentz@cmhburke.org",
            "affiliation": "N",
            "address_1": "809 JACKSON ST",
            "city": "BURKE",
            "state": "SD",
            "country_code": "US",
            "postal_code": "575230319",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Burke, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.