CHEYENNE RIVER BREAST & CERVICAL CANCER EARLY DETECTION PROGRAM — NPI 1861120552 (Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center in EAGLE BUTTE, SD)

CMS-1500 Box 24J / 33a • NPI

1861120552

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

261QR0206X

Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center

Box 32 Service Location & ZIP+4

24276 166TH ST, EAGLE BUTTE, SD, 57625-8141

✓ 9-Digit EDI 837 ZIP+4 (57625-8141)

Practice Phone & Referral Fax

(605) 964-0736

Fax: (605) 964-1176

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1861120552 (CHEYENNE RIVER BREAST & CERVICAL CANCER EARLY DETECTION PROGRAM) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1861120552` (NPI-2 Organization / Facility)
Provider / Legal Name	CHEYENNE RIVER BREAST & CERVICAL CANCER EARLY DETECTION PROGRAM
Plain-English Specialty	Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center NUCC Code: `261QR0206X` (Clinic/Center, Radiology, Mammography)
Certifying / Licensing Body	Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Practice Location Address	24276 166TH ST, EAGLE BUTTE, SD, 57625-8141
Practice Telephone / Fax	Tel: (605) 964-0736 \| Fax: (605) 964-1176
Administrative Mailing Address	PO BOX 590, EAGLE BUTTE, SD, 57625-0590
Enumeration & Last Sync	Enumerated: 2022-08-10 \| CMS Record Updated: 2022-08-11
Authorized Official	RAMONA SIMON (Tribal Health CEO)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

24276 166TH ST, EAGLE BUTTE, SD, 57625-8141

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Plain-English Taxonomy & CMS Crosswalk (261QR0206X)

What Does Taxonomy Code 261QR0206X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 261QR0206X translates to:
"Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Clinical Scope: Same-day outpatient consultations, urgent walk-in medical care, vaccinations, and day-case diagnostic procedures.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (CHEYENNE RIVER BREAST & CERVICAL CANCER EARLY DETECTION PROGRAM)

Typical CPT / Diagnostic Procedures:

Walk-In Urgent Care Evaluation, Point-of-Care Testing & X-Ray
Same-Day Ambulatory Endoscopy, Cataract & Minor Surgical Procedures

Common Therapeutic Classes:

Outpatient Oral Antimicrobials, Analgesics, Nebulizers & Vaccines

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`261Q00000X` — Clinic/Center Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary
`261QR0206X` — Clinic/Center, Radiology, Mammography Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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CHEYENNE RIVER BREAST & CERVICAL CANCER EARLY DETECTION PROGRAM (NPI #1861120552)