NPIMap

Organization Active NPI

Avera Gettysburg

Doing business as Avera Missouri River Health Center

  • Critical Access Hospital
  • Gettysburg, SD
National Provider Identifier
1003887266
Registry record updated Jul 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
10542 Issued in SD
Legal business name
AVERA GETTYSBURG
Doing business as
Avera Missouri River Health Center
Practice address
606 E Garfield Ave
Gettysburg, SD 57442-1325
Phone
(605) 765-2480
Fax
(605) 765-2704
NPI assigned
Jan 27, 2006
Last updated
Jul 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2022

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

Authorized official

Name
Mr. Mikel Holland
Title
Ceo/President
Phone
(605) 224-3144

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 10542 SD Primary

Addresses

Primary practice location

606 E Garfield Ave
Gettysburg, SD 57442-1325

Mailing address

606 E Garfield Ave
Gettysburg, SD 57442-1325
Phone (605) 765-2480

Other identifiers 3

IdentifierTypeStateIssuer
5500420MedicaidSD
0100420MedicaidSD
0159470MedicaidSD

Other names 1

  • Avera Missouri River Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061104000319 SD Part A Provider - Critical Access Hospital 4284619362 Receives reassigned benefits from 42 practitioners
Practice locations: Gettysburg, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003887266. Details of each certification follow.

Hospital certification: CCN 431302

Legal name
AVERA GETTYSBURG
Doing business as
AVERA MISSOURI RIVER HEALTH CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Aug 25, 1994
Last certification
Feb 25, 2026
Beds
7
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1952 in SD
Enrollment address
606 E Garfield Ave
Gettysburg, SD 57442-1325
Main/Primary Hospital Location

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

Other NPIs with the same Medicare PAC ID 2

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

  • Avera Gettysburg

    dba Avera Medical Group Gettysburg

    • Internal Medicine Physician
    • Gettysburg, SD
    • NPI 1366091357

    4284619362

    Same PAC ID
  • Avera Gettysburg

    dba Avera Missouri River Health Center (Swingbed)

    • Medicare Defined Swing Bed Hospital Unit
    • Gettysburg, SD
    • NPI 1881754497

    4284619362

    Same PAC ID

Care Compare: Hospital

Medicare Care Compare
Listed as
Avera Missouri River Health CenterCCN 431302 · 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
Avera Gettysburg3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

  • Avera Gettysburg

    dba Oahe Manor

    • Nursing Facility/Intermediate Care Facility
    • Gettysburg, SD
    • NPI 1790756963
    NPD tax ID
  • Avera Gettysburg

    dba Avera Missouri River Health Center (Swingbed)

    • Medicare Defined Swing Bed Hospital Unit
    • Gettysburg, SD
    • NPI 1881754497
    NPD tax ID

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

  • Avera St Marys

    dba Avera St. Mary's Hospital

    • General Acute Care Hospital
    • Pierre, SD
    • NPI 1669457180

    Member Of

    NPD member

Locations

606 E Garfield Ave
Gettysburg, SD 57442
Phone (605) 765-2273

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Avera St Marys Organization, Pierre, SD Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2013 100%
James Francis Dover Individual Corporate OfficerFache, President/Ceo Avera Health Oct 23, 2023
Robert Wylie Individual Corporate DirectorBoard Member Jul 1, 2021
Amy Kathryn Lueking Individual Corporate DirectorBoard Member Jul 1, 2021
Debra Ann Kolecka Individual Corporate DirectorBoard Member Jul 1, 2023
Kimberly Olson Individual Corporate DirectorBoard Member Jul 1, 2022
Michael Weisgram Individual Corporate DirectorBoard Member Jul 1, 2015
Rena J Robbennolt Individual Corporate DirectorBoard Member Jul 1, 2023
Meredith Lee Individual Corporate DirectorBoard Member Jul 1, 2023
Amanda Marie Schutz Individual Corporate OfficerOfficer Billing Services Jun 1, 2018
Julie Lautt Individual Corporate OfficerCfo Mar 1, 2020
Lynn Marie Welbig Individual Corporate DirectorBoard Member Jul 1, 2018
Jami Kay Cronin Individual Corporate DirectorBoard Member Jul 1, 2021
Shantel Shamiele Krebs Individual Corporate OfficerPresident/Ceo Mar 13, 2023
Operational/Managerial Control Mar 13, 2023
Mark L Hagy Individual Corporate DirectorBoard Member Jul 1, 2022
Avera Health Organization, Sioux Falls, SD Non-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2013 100%
Kristin Brost Individual Corporate DirectorBoard Member Jul 1, 2021

Owners & managing parties with NPI records 10

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

Facilities with the same owner 90

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

View all 90

Practitioners & affiliated clinicians

Practitioners 42

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.

View all 42

Affiliated clinicians 30

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

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657843200000",
    "number": "1003887266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "606 E GARFIELD AVE",
            "city": "GETTYSBURG",
            "state": "SD",
            "postal_code": "574421325",
            "telephone_number": "605-765-2480",
            "fax_number": "605-765-2704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 E GARFIELD AVE",
            "city": "GETTYSBURG",
            "state": "SD",
            "postal_code": "574421325",
            "telephone_number": "605-765-2480",
            "fax_number": "605-765-2704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA GETTYSBURG",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-27",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-15",
        "status": "A",
        "authorized_official_last_name": "HOLLAND",
        "authorized_official_first_name": "MIKEL",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "605-224-3144",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "SD",
            "license": "10542",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5500420",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0100420",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0159470",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Missouri River Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gettysburg, SD

Sources for this page

Verify at the official NPI Registry.