NPIMap

Organization Active NPI

Bowdle Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Bowdle, SD
National Provider Identifier
1003999152
Registry record updated Dec 29, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
BOWDLE HOSPITAL
Practice address
8001 West 5TH Street
Bowdle, SD 57428-0556
Phone
(605) 285-6146
Fax
(605) 285-6410
NPI assigned
Oct 23, 2006
Last updated
Dec 29, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2009

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

Authorized official

Name
Mr. Jon Kosiak
Title
Ceo
Phone
(605) 285-6146

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X NU Primary

Addresses

Primary practice location

8001 West 5TH Street
Bowdle, SD 57428-0556

Mailing address

PO Box 556
Bowdle, SD 57428-0556
Phone (605) 285-6146

Other identifiers 1

IdentifierTypeStateIssuer
0159490MedicaidSD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040325001225 SD Part B Supplier - Clinic/Group Practice 9335056902 Receives reassigned benefits from 6 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bowdle, SD
O20061104000301 SD Part A Provider - Critical Access Hospital 9335056902 Receives reassigned benefits from 1 practitioner
Practice locations: Bowdle, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003999152. Details of each certification follow.

Hospital certification: CCN 43Z318

Legal name
BOWDLE HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Dec 22, 2003 in SD
Enrollment address
8001 W 5TH St
Bowdle, SD 57428-2031
Hospital Swing-Bed Unit

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).

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Russell Maier Individual Corporate Officer May 1, 2023
City of Bowdle Organization, Bowdle, SD 5% Or Greater Direct Ownership Interest Feb 1, 1987 100%
Margaret Bobby Individual Corporate Officer May 1, 2022
Amber Shaykett Individual Corporate Officer Sep 1, 2022
Darwyn Kleffman Individual Corporate OfficerCeo May 20, 2019
W-2 Managing EmployeeCeo May 20, 2019
Michael Gunderson Individual Corporate DirectorBoard Member May 1, 2017
Rick Boschee Individual Corporate DirectorChairman of the Board Nov 25, 2002
Rex Gab Individual Corporate DirectorBoard Member May 2, 2016

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Practitioners 7

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 3

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": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262044800000",
    "number": "1003999152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 556",
            "city": "BOWDLE",
            "state": "SD",
            "postal_code": "574280556",
            "telephone_number": "605-285-6146",
            "fax_number": "605-285-6410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8001 WEST 5TH STREET",
            "city": "BOWDLE",
            "state": "SD",
            "postal_code": "574280556",
            "telephone_number": "605-285-6146",
            "fax_number": "605-285-6410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOWDLE HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2009-12-29",
        "status": "A",
        "authorized_official_last_name": "KOSIAK",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "605-285-6146",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0159490",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowdle, SD

Sources for this page

Verify at the official NPI Registry.