NPIMap

Organization Active NPI

Avera St Marys

Doing business as Avera St Marys Hospital ER CRNA

  • Emergency Medicine Physician
  • Pierre, SD
National Provider Identifier
1073305496
Registry record updated Aug 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
AVERA ST MARYS
Doing business as
Avera St Marys Hospital ER CRNA
Practice address
801 E Sioux Ave
Pierre, SD 57501-3323
Phone
(605) 224-3100
NPI assigned
May 21, 2025
Last updated
Aug 18, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2025

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

Authorized official

Name
Shantel Krebs
Title
President/Ceo
Phone
(605) 351-5916

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU Primary
Certified Registered Nurse Anesthetist 367500000X NU

Addresses

Primary practice location

801 E Sioux Ave
Pierre, SD 57501-3323

Mailing address

PO Box 860674
Minneapolis, MN 55486-0001

Other names 1

  • Avera St Marys Hospital ER CRNA Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040225000579 SD Part B Supplier - Clinic/Group Practice 0143134965 Receives reassigned benefits from 228 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pierre, SD

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Jon Vandermaten PA C11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

310 Smith Ave N
Ste 440
Saint Paul, MN 55102
Phone (651) 241-6550

1211 E Wells Ave
Pierre, SD 57501
Phone (605) 224-3100

717 E Dakota Ave
Pierre, SD 57501
Phone (605) 224-3163

Practitioners & affiliated clinicians

Practitioners 226

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 226

NPI Registry JSON

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

{
    "created_epoch": "1747785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755475200000",
    "number": "1073305496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860674",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554860001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 E SIOUX AVE",
            "city": "PIERRE",
            "state": "SD",
            "postal_code": "575013323",
            "telephone_number": "605-224-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA ST MARYS",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-21",
        "last_updated": "2025-08-18",
        "certification_date": "2025-08-18",
        "status": "A",
        "authorized_official_last_name": "KREBS",
        "authorized_official_first_name": "SHANTEL",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "605-351-5916"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera St Marys Hospital ER CRNA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avera St Marys Hospital ER CRNA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pierre, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.