Active NPI
Holly Humphries
- Registered Nurse
- Pine Ridge, SD
National Provider Identifier
1750838074
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 262299
- Practice address
- East Highway 18
Pine Ridge, SD 57770 - Phone
- (605) 867-3006
- NPI assigned
- Sep 2, 2016
- Last updated
- Sep 2, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 262299 | NC | Primary |
Addresses
Primary practice location
East Highway 18
Pine Ridge, SD 57770
Mailing address
PO Box 1201
Pine Ridge, SD 57770-1201
Phone (605) 867-3006
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497786412 | Medicaid | SD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 262299 | NC | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pine Ridge Indian Health Service Hospital | Past | Accepting new patients | |
| Pine Ridge Indian Health Service Hospital | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Pine Ridge IHS Hospital
- General Acute Care Hospital
- Pine Ridge, SD
- NPI 1497786412
-
dba Wanblee Health Center
- Clinic/Center
- Wanblee, SD
- NPI 1962559518
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472774400000",
"number": "1750838074",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1201",
"city": "PINE RIDGE",
"state": "SD",
"postal_code": "577701201",
"telephone_number": "605-867-3006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "EAST HIGHWAY 18",
"city": "PINE RIDGE",
"state": "SD",
"postal_code": "57770",
"telephone_number": "605-867-3006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUMPHRIES",
"first_name": "HOLLY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-09-02",
"last_updated": "2016-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NC",
"license": "262299",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1497786412",
"state": "SD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pine Ridge, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.