City of Brookings
Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Brookings, SD
NPI 1962584052 · NPPES record last updated Dec 4, 2018
Key facts
- NPI
- 1962584052
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medicare Defined Swing Bed Hospital Unit 275N00000X
- Legal business name
- CITY OF BROOKINGS
- Practice address
- 300 22ND Ave
Brookings, SD 57006-2480 - Phone
- (605) 696-9000
- Fax
- (605) 696-7728
- NPI assigned
- Oct 19, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Melissa Wagner
- Title
- Cfo
- Phone
- (605) 696-9000
Owners & managing parties with NPI records 8
Owned or controlled facilities with NPI records 10
Other NPIs with the same Medicare PAC ID 8
Corporate family (same tax ID) 12
Related certifications (CCN) 4
Facilities with the same owner 5
Practitioners 112
-
Emily Abele, M.D.
-
Lindsey Anderson, MA, CCC-SLP
-
David D Axtman, MS PA-C
-
Amy L. Bakker, PAC
-
Jackie Joanne Bau, FNP-C
-
Larissa Bennis, MD
-
Dileep S Bhat, M D
-
Matt N. Bien, MD
-
Travis Bolstad, DPT
-
Tonya D Buchholz, CNP
-
Natalie Grace Buenger, PT, DPT
-
Kari Ann Bunkers, CRNA
-
Daniel Cecil, MD
-
Tammy Jean Crofutt, CNP
-
Morgan Derungs, FNP
-
Jason Domagalski, PA
-
Shelby Eischens, MD
-
Abbie Lynn Entringer, CNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SD
Hospital certification: CCN 43U008
- Legal name
- CITY OF BROOKINGS
- Doing business as
- BROOKINGS HEALTH SYSTEM
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 300 22ND Ave
Brookings, SD 57006-2474 - Hospital subgroups
- Swing-bed approved
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| City of Brookings |
5% Or Greater Direct Ownership Interest | Jun 8, 2010 | |
| Jason R Merkley |
Corporate Officer |
Dec 5, 2011 | |
| W-2 Managing Employee |
Dec 5, 2011 | ||
| Melissa Wagner |
Corporate Officer |
Sep 15, 2018 | |
| W-2 Managing Employee | Sep 15, 2018 |
All facility ownership & control disclosures 7
| Facility | Type | Role | Since |
|---|---|---|---|
| Brookings Health System |
Hospital | 5% Or Greater Direct Ownership Interest | Jun 8, 2010 |
| Brookings Health System the Neighborhoods at Brookview |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Adp of the SNF |
Mar 21, 1970 Mar 21, 1970 |
| Brookings Health System |
Home health agency | Other (100%) | Nov 9, 2011 |
| Brookings Health System |
Hospice | Other (100%) | Jul 1, 1966 |
| Brookings Health System Arlington Medical Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest | May 1, 2010 |
| Brookings Health System White Medical Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 1966 |
| Brookings Health System Volga Medical Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2014 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101109001521 | SD | Part a Provider - Hospital | 1052307105 | Practice locations: Brookings, SD |
National Provider Directory
- Tax ID family
- Brookings Hospital
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | Yes |
Addresses
Primary practice location
300 22ND Ave
Brookings, SD 57006-2480
Mailing address
300 22ND Ave
Brookings, SD 57006-2480
Phone (605) 696-9000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0159530 | Medicaid | SD |
Other names
- Brookings Health System
Other providers in Brookings, SD
- City of Brookings
- City of Brookings
- City of Brookings
- City of Brookings
- City of Brookings
- City of Brookings
- Clear Reflections Counseling and Consulting, LLC
- Steven Michel Clites
- Commit to Change ABA Therapy and Consulting, LLC
- Complete Care Chiropractic PC
All providers in Brookings, SD · Medicare Defined Swing Bed Hospital Unit in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 4, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.