Individual provider Active NPI

Merritt G. Warren, MD

  • Family Medicine Physician
  • Brookings, SD
National Provider Identifier
1497705461
Registry record updated Sep 24, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2543 Issued in SD
Practice address
400 22ND Ave.
Brookings, SD 57006-2497
Phone
(605) 697-9500
Fax
(605) 697-6939
NPI assigned
May 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2543 SD Primary

Addresses

Primary practice location

400 22ND Ave.
Brookings, SD 57006-2497

Mailing address

400 22ND Ave.
Brookings, SD 57006-2497
Phone (605) 697-9500

Other identifiers 1

IdentifierTypeStateIssuer
5602152MedicaidSD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040825000085 SD Practitioner - Family Practice 7517931587 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince Sep 1, 2004 Accepting new patients
Avera McKennan Current Accepting new patients
Avera McKennan CurrentSince Sep 1, 2004 Accepting new patients

Locations

104 W Birch St
Arlington, SD 57212
Phone (605) 983-3283

400 22nd Ave
Brookings, SD 57006
Phone (605) 692-6236

300 22nd Ave
Brookings, SD 57006
Phone (605) 692-6351

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190592000000",
    "number": "1497705461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 22ND AVE.",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "570062497",
            "telephone_number": "605-697-9500",
            "fax_number": "605-697-6939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 22ND AVE.",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "570062497",
            "telephone_number": "605-697-9500",
            "fax_number": "605-697-6939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARREN",
        "first_name": "MERRITT",
        "middle_name": "G.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2007-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "2543",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5602152",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookings, SD

Sources for this page

Verify at the official NPI Registry.