NPIMap

Individual provider Active NPI

Kerry Alan Blackham, DO

  • Geriatric Medicine (Family Medicine) Physician
  • Philip, SD
National Provider Identifier
1922014273
Registry record updated Jan 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
9452 Issued in SD
Practice address
503 W Pine St
Philip, SD 57567-0550
Phone
(605) 859-2566
Fax
(605) 859-2948
NPI assigned
Jul 31, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 9, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QG0300X 9452 SD Primary

Addresses

Primary practice location

503 W Pine St
Philip, SD 57567-0550

Mailing address

503 West Pine
Philip, SD 57567-0550
Phone (605) 859-2566

Other identifiers 1

IdentifierTypeStateIssuer
S110986MedicaidSD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160823000327 SD Practitioner - General PracticePractitioner - Geriatric Medicine 6800789439 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General PracticeAlso: Geriatric Medicine
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Philip Health Services IncGroup PAC ID 7214831866, 6 clinicians

Practice addresses (Care Compare)

503 W Pine St
Philip, SD 57567-3300
Phone (605) 859-2566

Hospital & facility affiliations

  • Hans P Peterson Memorial Hospital - Cah Hospital, Philip, SD, CCN 431319
  • Monument Health Rapid City Hospital Hospital, Rapid City, SD, CCN 430077
  • Bennett County Hospital and Nursing Home - Cah Hospital, Martin, SD, CCN 431314
  • Hans P Peterson Memorial Hospital - Cah Nursing home, CCN 43Z319

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Philip Health Services, Inc. Multi-Specialty CurrentSince Jul 18, 2016 Accepting new patients
Philip Health Services, Inc. CurrentSince Jul 18, 2016 Accepting new patients
Philip Clinic PastSince Mar 28, 2021 Accepting new patients
Kadoka Nursing Home Ass. Past Accepting new patients
Philip Health Services, Inc. Past Accepting new patients

Locations

503 W Pine St
Philip, SD 57567
Phone (605) 859-2511

Organizations & group practices 7

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.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546992000000",
    "number": "1922014273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 WEST PINE",
            "city": "PHILIP",
            "state": "SD",
            "postal_code": "575670550",
            "telephone_number": "605-859-2566",
            "fax_number": "605-859-2948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 W PINE ST",
            "city": "PHILIP",
            "state": "SD",
            "postal_code": "575670550",
            "telephone_number": "605-859-2566",
            "fax_number": "605-859-2948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKHAM",
        "first_name": "KERRY",
        "middle_name": "ALAN",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2019-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "SD",
            "license": "9452",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "S110986",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philip, SD

Sources for this page

Verify at the official NPI Registry.