NPIMap

Organization Active NPI

Fort Yates Indian Health Service Hospital

  • Health Service Clinic/Center
  • Bullhead, SD
National Provider Identifier
1497347579
Registry record updated Feb 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
FORT YATES INDIAN HEALTH SERVICE HOSPITAL
Practice address
102 Tasunka Street
Bullhead, SD 57621
Phone
(605) 823-4991
Fax
(605) 823-2150
NPI assigned
Feb 9, 2021
Last updated
Feb 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2024

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

Authorized official

Name
Jana Rhea Gipp
Title
Chief Executive Officer
Phone
(701) 854-8211

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X Primary

Addresses

Primary practice location

102 Tasunka Street
Bullhead, SD 57621

Mailing address

PO Box J
Fort Yates, ND 58538-0527
Phone (701) 854-3831

Other names 2

  • BULLHEAD HEALTH STATION Other name
  • Bullhead Indian Health Service Clinic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201203001462 ND Part A Provider - Critical Access Hospital 3678462744 Receives reassigned benefits from 1 practitioner
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bullhead, SD; Fort Yates, ND; McLaughlin, SD; Wakpala, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497347579. Details of each certification follow.

Hospital certification: CCN 351364

Legal name
FORT YATES INDIAN HEALTH SERVICE HOSPITAL
Doing business as
STANDING ROCK SERVICE UNIT
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Oct 29, 2021
Last certification
Oct 29, 2021
Beds
12
Ownership / control type
Federal
Organization structure
OtherNon-profit
Incorporated
Nov 10, 2020 in ND
Enrollment address
10 North River Road
Fort Yates, ND 58538-0527
Main/Primary Hospital Location

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Standing Rock Service UnitCCN 351364 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - Federal
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Fort Yates Indian Hosp Pharmacy16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Johnathon Largo Individual W-2 Managing EmployeeHealth Systems Specialist Oct 1, 2020
Tabitha Silk Individual Other Oct 1, 2020
Jana Gipp Individual Corporate DirectorChief Executive Officer Nov 1, 2013
Fort Yates Indian Health Service Hospital Organization, Fort Yates, ND Non-profit Operational/Managerial Control Oct 23, 1995

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 40

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 40

Affiliated clinicians 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1612828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707350400000",
    "number": "1497347579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX J",
            "city": "FORT YATES",
            "state": "ND",
            "postal_code": "585380527",
            "telephone_number": "701-854-3831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 TASUNKA STREET",
            "city": "BULLHEAD",
            "state": "SD",
            "postal_code": "57621",
            "telephone_number": "605-823-4991",
            "fax_number": "605-823-2150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT YATES INDIAN HEALTH SERVICE HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-09",
        "last_updated": "2024-02-08",
        "certification_date": "2024-02-08",
        "status": "A",
        "authorized_official_last_name": "GIPP",
        "authorized_official_first_name": "JANA",
        "authorized_official_middle_name": "RHEA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "701-854-8211"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BULLHEAD HEALTH STATION",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Bullhead Indian Health Service Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bullhead, SD

Sources for this page

Verify at the official NPI Registry.