NPIMap

Organization Active NPI

City of Brookings

  • Rural Health Clinic/Center
  • Volga, SD
National Provider Identifier
1811318074
Registry record updated Dec 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CITY OF BROOKINGS
Practice address
210 Kasan Ave
Volga, SD 57071
Phone
(605) 627-5701
NPI assigned
Dec 13, 2013
Last updated
Dec 4, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2018

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

Authorized official

Name
Mrs. Melissa Wagner
Title
Cfo
Phone
(605) 696-9000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

210 Kasan Ave
Volga, SD 57071

Mailing address

300 22ND Ave
Brookings, SD 57006-2480
Phone (605) 696-9000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040423000002 SD Part B Supplier - Clinic/Group Practice 1052307105 Receives reassigned benefits from 171 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: White, SD; Volga, SD; Madison, SD; Flandreau, SD; Dell Rapids, SD; De Smet, SD; Brookings, SD; Arlington, SD
O20140909001033 SD Part A Provider - Rural Health Clinic 1052307105 Practice locations: Volga, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811318074. Details of each certification follow.

Rural health clinic certification: CCN 433438

Legal name
CITY OF BROOKINGS
Doing business as
BROOKINGS HEALTH SYSTEM VOLGA MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 25, 2015
Last certification
Jul 11, 2023
Ownership / control type
2B
Organization structure
OtherNon-profit
Enrollment address
210 Kasan Ave
Volga, SD 57071
Related CCNs
430008

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
43D0406930Volga Clinic210 Kasan Avenue, Volga, SD 57071Provider-performed microscopyAug 16, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
City of Brookings Organization, Brookings, SD 5% Or Greater Direct Ownership Interest Jan 1, 2014 100%
Jason R Merkley Individual Corporate OfficerCeo Dec 5, 2011
W-2 Managing EmployeeCeo Jul 1, 2014
Melissa Wagner Individual Corporate OfficerCfo Sep 15, 2018
W-2 Managing Employee Sep 15, 2018

Owners & managing parties with NPI records 8

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

  • City of Brookings

    dba Brookings Health System

    • General Acute Care Hospital
    • Brookings, SD
    • NPI 1275515579

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Brookings

    dba Brookings Health System

    • Community Based Hospice Care Agency
    • Brookings, SD
    • NPI 1306928494

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Brookings

    dba Brookings Health System

    • Skilled Nursing Facility
    • Brookings, SD
    • NPI 1417039504

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Brookings

    dba Brookings Health System

    • Home Health Agency
    • Brookings, SD
    • NPI 1861574956

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Brookings

    dba Brookings Health System Arlington Medical Center

    • Rural Health Clinic/Center
    • Arlington, SD
    • NPI 1902123581

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Brookings

    dba Brookings Health System White Clinic

    • Rural Health Clinic/Center
    • White, SD
    • NPI 1912279829

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Brookings

    dba Brookings Health System

    • Anesthesiology Physician
    • Brookings, SD
    • NPI 1932281029

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Brookings

    dba Brookings Health System

    • Medicare Defined Swing Bed Hospital Unit
    • Brookings, SD
    • NPI 1962584052

    5% Or Greater Direct Ownership Interest

    CMS ownership

All facility ownership & control disclosures 7

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Brookings Health SystemBrookings, SD, CCN 430008 Hospital 5% Or Greater Direct Ownership Interest Jun 8, 2010
Brookings Health SystemBrookings, SD, CCN 43U008 Hospital 5% Or Greater Direct Ownership Interest Jun 8, 2010
Brookings Health System the Neighborhoods at BrookviewBrookings, SD, CCN 435083 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF		 Mar 21, 1970
Mar 21, 1970
Brookings Health SystemBrookings, SD, CCN 437030 Home health agency Other (100%) Nov 9, 2011
Brookings Health SystemBrookings, SD, CCN 431509 Hospice Other (100%) Jul 1, 1966
Brookings Health System Arlington Medical ClinicArlington, SD, CCN 433433 Rural health clinic 5% Or Greater Direct Ownership Interest May 1, 2010
Brookings Health System White Medical ClinicWhite, SD, CCN 433436 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966

Owned or controlled facilities with NPI records 10

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • City of Brookings

    dba Avera Medical Group a Department of Brookings Health System

    • Multi-Specialty Clinic/Center
    • Brookings, SD
    • NPI 1134558158

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Brookings

    dba Brookings Health System

    • General Acute Care Hospital
    • Brookings, SD
    • NPI 1275515579

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Brookings

    dba Brookings Health System

    • Community Based Hospice Care Agency
    • Brookings, SD
    • NPI 1306928494

    Other

    CMS ownership
  • City of Brookings

    dba Brookings Health System

    • Skilled Nursing Facility
    • Brookings, SD
    • NPI 1417039504

    5% Or Greater Direct Ownership Interest, Adp of the SNF

    CMS ownership
  • City of Brookings

    dba Brookings Health System

    • Home Health Agency
    • Brookings, SD
    • NPI 1861574956

    Other

    CMS ownership
  • City of Brookings

    dba Brookings Health System Arlington Medical Center

    • Rural Health Clinic/Center
    • Arlington, SD
    • NPI 1902123581

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Brookings

    dba Brookings Health System White Clinic

    • Rural Health Clinic/Center
    • White, SD
    • NPI 1912279829

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Brookings

    dba Brookings Health System

    • Anesthesiology Physician
    • Brookings, SD
    • NPI 1932281029

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Brookings

    dba Brookings Health System

    • Medicare Defined Swing Bed Hospital Unit
    • Brookings, SD
    • NPI 1962584052

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Brookings

    dba Avera Medical Group Specialty Care Brookings a Department of Brookings

    • Multi-Specialty Clinic/Center
    • Brookings, SD
    • NPI 1982057246

    5% Or Greater Direct Ownership Interest

    CMS ownership

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1386892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543881600000",
    "number": "1811318074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 22ND AVE",
            "city": "BROOKINGS",
            "state": "SD",
            "postal_code": "570062480",
            "telephone_number": "605-696-9000",
            "fax_number": "605-696-7751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 KASAN AVE",
            "city": "VOLGA",
            "state": "SD",
            "postal_code": "57071",
            "telephone_number": "605-627-5701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF BROOKINGS",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-13",
        "last_updated": "2018-12-04",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "605-696-9000",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Volga, SD

Sources for this page

Verify at the official NPI Registry.