NPIMap

Organization Active NPI

St. Benedict Health Center

Doing business as Avera St. Benedict Certified Rural Health Clinic, Lake Andes

  • Rural Health Clinic/Center
  • Lake Andes, SD
National Provider Identifier
1114931797
Registry record updated Nov 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ST. BENEDICT HEALTH CENTER
Doing business as
Avera St. Benedict Certified Rural Health Clinic, Lake Andes
Practice address
756 East Lake Street
Lake Andes, SD 57356
Phone
(605) 487-7878
Fax
(605) 487-9566
NPI assigned
Jul 28, 2006
Last updated
Nov 30, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2022

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

Authorized official

Name
Lindsay R WeberNPI 1770867715
Title
Ceo
Phone
(605) 928-3311

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

756 East Lake Street
Lake Andes, SD 57356

Mailing address

PO Box 279
Lake Andes, SD 57356-0279
Phone (605) 487-7878

Other identifiers 1

IdentifierTypeStateIssuer
5340060MedicaidSD

Other names 1

  • Avera St. Benedict Certified Rural Health Clinic, Lake Andes Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040129001118 SD Part B Supplier - Clinic/Group Practice 4880507672 Receives reassigned benefits from 27 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Parkston, SD
O20100609000427 SD Part A Provider - Rural Health Clinic 4880507672 Practice locations: Lake Andes, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114931797. Details of each certification follow.

Rural health clinic certification: CCN 433408

Legal name
ST BENEDICT HEALTH CENTER
Doing business as
AVERA ST BENEDICT CERTIFIED RURAL HEALTH CLINIC/LAKE ANDES SITE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 24, 2000
Last certification
Apr 25, 2019
Ownership / control type
1B
Organization structure
CorporationNon-profit
Incorporated
Aug 25, 2000 in SD
Enrollment address
756 E Lake St
Lake Andes, SD 57356-2001

Other NPIs with the same Medicare PAC ID 4

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

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

Locations

310 S Main St
Tripp, SD 57376
Phone (605) 935-6089

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Patricia Leischner Individual Corporate DirectorBoard Member Jul 1, 2019
Barbara Weidenbach Individual Corporate DirectorBoard Member Jul 1, 2019
Patricia Prunty Individual Corporate DirectorBoard Member Jul 1, 2019
Pat Reiner Individual Corporate DirectorBoard Member Jul 1, 2019
Lindsay Rae Weber Individual Corporate OfficerPresident/Ceo Sep 1, 2022
Operational/Managerial Control Sep 1, 2022
Denette Leifeld Individual Corporate DirectorBoard Member Jul 1, 2020
Richard Boettcher Individual Corporate DirectorBoard Member Jul 1, 2019
Julie Lautt Individual Corporate OfficerCfo Mar 1, 2020
Antoinette J Vanderpol Individual Corporate DirectorBoard Member Jul 1, 2019
Bobby Lynn Sutton Individual Corporate OfficerCeo Avera Health Jun 18, 2018
Shayne McIntosh Individual Corporate DirectorBoard Member Jul 1, 2019
Avera Health Organization, Sioux Falls, SD Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2000 100%
Robert Just Individual Corporate DirectorBoard Member Jul 1, 2019

Owners & managing parties with NPI records 2

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 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669766400000",
    "number": "1114931797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 279",
            "city": "LAKE ANDES",
            "state": "SD",
            "postal_code": "573560279",
            "telephone_number": "605-487-7878",
            "fax_number": "605-487-9566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "756 EAST LAKE STREET",
            "city": "LAKE ANDES",
            "state": "SD",
            "postal_code": "57356",
            "telephone_number": "605-487-7878",
            "fax_number": "605-487-9566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. BENEDICT HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-28",
        "last_updated": "2022-11-30",
        "certification_date": "2022-11-30",
        "status": "A",
        "authorized_official_last_name": "WEBER",
        "authorized_official_first_name": "LINDSAY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "605-928-3311"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5340060",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera St. Benedict Certified Rural Health Clinic, Lake Andes",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avera St. Benedict Certified Rural Health Clinic, Lake Andes",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Andes, SD

Sources for this page

Verify at the official NPI Registry.