Douglas County Memorial Hospital

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

DOUGLAS COUNTY MEMORIAL HOSPITAL

Doing business as

Prairie Health Clinic Wagner

Practice address

310 W SD Highway 46
Wagner, SD 57380-9304

Phone

(605) 724-2151

NPI assigned

Jan 16, 2009

Last updated

Dec 6, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Nicole J Neugebauer

Title

CPC, CPC-H

Phone

(605) 724-2151

Specialties & licenses 1

Addresses

Other names 1

• Prairie Health Clinic Wagner Doing business as

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

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

• Douglas County Memorial Hospital

  dba Prairie Health Clinic - Corsica

  • Rural Health Clinic/Center
  • Corsica, SD
  • NPI 1003879958

  O20040325001576

  Same enrollment
• Douglas County Memorial Hospital

  • Critical Access Hospital
  • Armour, SD
  • NPI 1518155217

  O20040325001576

  Same enrollment

Practitioners 3

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.

• Nicole Lynn Bamberg, CNP

  • Nurse Practitioner
  • Fort Thompson, SD
  • NPI 1043702244
  NPD
• Marlys Luebke, M.D.

  • Family Medicine Physician
  • Armour, SD
  • NPI 1396738316
  NPD
• George Alfred Nicholas, M.D.

  • Family Medicine Physician
  • Huron, SD
  • NPI 1356388995
  NPD

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

{
    "created_epoch": "1232064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323129600000",
    "number": "1609013317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 W SD HIGHWAY 46",
            "city": "WAGNER",
            "state": "SD",
            "postal_code": "573809304",
            "telephone_number": "605-384-4577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 W SD HIGHWAY 46",
            "city": "WAGNER",
            "state": "SD",
            "postal_code": "573809304",
            "telephone_number": "605-724-2151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOUGLAS COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-16",
        "last_updated": "2011-12-06",
        "status": "A",
        "authorized_official_last_name": "NEUGEBAUER",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CPC, CPC-H",
        "authorized_official_telephone_number": "605-724-2151"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prairie Health Clinic Wagner",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Adelia Mae Cuka, CNS,RN,MSN
• Judy Cuka
• Wanda Jean Dally, MT
• Janet Larsen Deloughery, R.D.L.N.
• Dylan Dethlefsen, CSW, QMHP
• Berkley A Erickson, CNP
• Gretchen Marie Esplund, MD
• Joan Fillaus, RDH
• First Chiropractic Centers, PC (First Chiropractic Center)
• Jay Joseph Fitzgerald, D.C.

• Rural Health Clinic/Center in Wagner, SD
• Providers in Wagner, SD by specialty
• Rural Health Clinic/Center in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2011; 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.