NPIMap

Organization Active NPI

Community Memorial Hospital, Inc

  • Critical Access Hospital
  • Burke, SD
National Provider Identifier
1902849516
Registry record updated Oct 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
10530 Issued in SD
Legal business name
COMMUNITY MEMORIAL HOSPITAL, INC
Practice address
809 Jackson St
Burke, SD 57523-0319
Phone
(605) 775-2631
NPI assigned
Jun 13, 2006
Last updated
Oct 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2022

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

Authorized official

Name
Mistie Drey III
Title
Ceo
Phone
(605) 775-2621

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 10530 SD Primary

Addresses

Primary practice location

809 Jackson St
Burke, SD 57523-0319

Mailing address

809 Jackson St
Burke, SD 57523-0319
Phone (605) 775-2631

Other identifiers 2

IdentifierTypeStateIssuer
0100740MedicaidSD
5500740MedicaidSD

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lynne.bentz@cmhburke.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061104000399 SD Part A Provider - Critical Access Hospital 2163317900 Receives reassigned benefits from 9 practitioners
Practice locations: Burke, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902849516. Details of each certification follow.

Hospital certification: CCN 431309

Legal name
COMMUNITY MEMORIAL HOSPITAL INC
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jan 23, 1997
Last certification
Apr 26, 2023
Beds
16
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Apr 23, 1945 in SD
Enrollment address
809 Jackson St
Burke, SD 57523-2065
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 3

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Community Memorial HospitalCCN 431309 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Community Memorial Hospital5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Lynne Bentz Individual W-2 Managing EmployeeBilling Dec 18, 2017
Mistie R Drey Individual Corporate OfficerCeo Sep 18, 2015
W-2 Managing EmployeeCeo Sep 18, 2015
Douglas Spitzenberger Individual Corporate DirectorBoard Member Mar 31, 2019
Jason Mosterd Individual Corporate DirectorDirector Jul 1, 2021
Larry Shepperd Individual Corporate DirectorDirector Jul 1, 2022
Dillon Lambley Individual Corporate DirectorDirector Jul 1, 2023
Karen Martin Individual Corporate DirectorBoard Member Apr 1, 2007
Rachelle Norberg Individual Corporate DirectorSecretary Apr 1, 2019
Clayton Steele Individual Corporate DirectorBoard Member Apr 1, 2011
Michael Karbo Individual Corporate DirectorChairman Apr 1, 2006
Rebecca Jones Individual Corporate DirectorBoard Member Apr 1, 2018

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.

Affiliated clinicians 12

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

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666656000000",
    "number": "1902849516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 JACKSON ST",
            "city": "BURKE",
            "state": "SD",
            "postal_code": "575230319",
            "telephone_number": "605-775-2631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 JACKSON ST",
            "city": "BURKE",
            "state": "SD",
            "postal_code": "575230319",
            "telephone_number": "605-775-2631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEMORIAL HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-13",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-25",
        "status": "A",
        "authorized_official_last_name": "DREY",
        "authorized_official_first_name": "MISTIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "605-775-2621",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "SD",
            "license": "10530",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0100740",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5500740",
            "state": "SD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lynne.bentz@cmhburke.org",
            "affiliation": "N",
            "address_1": "809 JACKSON ST",
            "city": "BURKE",
            "state": "SD",
            "country_code": "US",
            "postal_code": "575230319",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Burke, SD

Sources for this page

Verify at the official NPI Registry.