Avera Queen of Peace
Organization Active NPI Skilled Nursing Facility · Mitchell, SD
NPI 1144225129 · NPPES record last updated Aug 20, 2020
Key facts
- NPI
- 1144225129
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 10652 (SD)
- Legal business name
- AVERA QUEEN OF PEACE
- Practice address
- 500 S Ohlman St
Mitchell, SD 57301-3109 - Phone
- (605) 996-7701
- NPI assigned
- Jun 16, 2005
- Organization subpart
- Yes
- Parent organization (as reported)
- AVERA QUEEN OF PEACE
Authorized official
- Name
- Douglas Ekeren
- Title
- President/Ceo
- Phone
- (605) 668-8322
Owners & managing parties with NPI records 4
-
Jessica Claussen, MD
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 11
Corporate family (same tax ID) 28
Facilities with the same owner 90
Practitioners 122
-
Benjamin Curtiss Abbey, PA-C
-
Megan E Albertson, M.D.
-
Alese M Allerdings, M.D.
-
Carly Anne Alley, PT, DPT
-
Aaron Paul Baas, MD
-
Dalton Baird, MD
-
Phillip J Becker, MD
-
Kelsey Marie Bender, PHYSICIAN ASSISTANT
-
Matthew Alvin Bosma, DPT
-
Kevin B Bray, MD
-
Michelle R Bultje, CRNA
-
Ahna Buntrock, MD
-
Sabina Choudhry, MD
-
Erika Nicole Clark, OTD, OTR/L
-
Jessica Claussen, MD
-
Brittany Lynn Deckert, DPT, ATC
-
Rachel Dykstra, CNP
-
Karley Fischer, PA-C
Affiliated clinicians 10
-
Aaron Paul Baas, MD
-
Kassidy Boyd, M.D.
-
Michael Gerlach, MD
-
Douglas Holum, MD
-
Paul Rasmussen, MD
-
Nathan J Timmer, MD
Medicare Care Compare: Nursing home
- Listed as
- Avera Brady Health and Rehab
- Overall star rating
- ★★★★★ 5 of 5
- Health inspections
- ★★★★★ 5 of 5
- Staffing
- ★★★★★ 5 of 5
- Quality measures
- ★★★★☆ 4 of 5
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- Oct 1, 1991
- Medicare certification status
- Active
- Certified beds
- 84 · 75.2 residents per day on average
- Chain
- Avera Health
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 43D0683775 | Avera Brady Health & Rehab | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SD
Skilled nursing facility certification: CCN 435061
- Legal name
- AVERA QUEEN OF PEACE
- Doing business as
- AVERA BRADY HEALTH AND REHAB
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Oct 1, 1991
- Last certification
- Dec 12, 2024
- Beds
- 84
- Ownership / control type
- Nonprofit Corporation
- Multi-facility organization
- Avera Health
- Organization structure
- Corporation · Non-profit
- Incorporated
- Nov 1, 1908 in SD
- Enrollment address
- 500 S Ohlman St
Mitchell, SD 57301-3109 - Nursing home name
- AVERA BRADY HEALTH AND REHAB
- Affiliated entity
- AVERA HEALTH
All disclosed owners & managing parties 21
| Name | Role | Since | Share |
|---|---|---|---|
| James Francis Dover |
Corporate Officer |
Oct 23, 2023 | |
| Trevor Dierks |
Managing Control - Governing Body |
Jul 1, 2023 | |
| Lucio N Margallo |
Corporate Director |
Jul 1, 2020 | |
| Operational/Managerial Control | Jul 1, 2020 | ||
| Adp of the SNF | Feb 12, 2026 | ||
| Brad Zomer |
Managing Control - Governing Body |
Jul 1, 2018 | |
| Diane Sandhoff |
Managing Control - Governing Body |
Jul 1, 2023 | |
| Fredel Thomas |
Managing Control - Governing Body |
Jul 1, 2024 | |
| Kimberly Jane Longe |
Corporate Officer |
Jun 1, 2024 | |
| Operational/Managerial Control | Jun 1, 2024 | ||
| Adp of the SNF | Feb 12, 2026 | ||
| Ryan Thompson |
Managing Control - Governing Body |
Jul 1, 2018 | |
| Joyce Feteral |
Managing Control - Governing Body |
Jul 1, 2024 | |
| |
General Partnership Interest | Dec 1, 2000 | |
| Limited Partnership Interest | Dec 1, 2000 | ||
| Adp of the SNF | Feb 12, 2026 | ||
| Vicky Larson |
Managing Control - Governing Body |
Jul 1, 2024 | |
| Ann Buckmiller |
Managing Control - Governing Body |
Jul 1, 2025 | |
| Jennifer L Tegethoff |
Managing Control - Governing Body |
Jul 1, 2021 | |
| Julie Lautt |
Corporate Officer |
Mar 1, 2020 | |
| Hilary Rae Rockwell |
Corporate Officer |
Jul 1, 2023 | |
| Operational/Managerial Control | Jul 1, 2023 | ||
| Mark Puetz |
Managing Control - Governing Body |
Jul 1, 2023 | |
| Avera Health |
5% Or Greater Direct Ownership Interest | Jul 1, 2009 | 100% |
| Darlene Bergeleen |
Managing Control - Governing Body |
Jul 1, 2023 | |
| Jessica a Claussen |
Managing Control - Governing Body |
Jul 1, 2023 | |
| Mark Hunhoff |
Managing Control - Governing Body |
Jul 1, 2019 | |
| Nicole Stahle |
Managing Control - Governing Body |
Jul 1, 2023 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Avera Weskota Memorial Medical Center |
Hospital | Operational/Managerial Control | Jun 1, 2000 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20091209000245 | SD | Part a Provider - Skilled Nursing Facility | 9335050806 | Practice locations: Mitchell, SD |
National Provider Directory
- Tax ID family
- ER Phy
- Part of
- ER Phy
Locations
500 S Ohlman St
Mitchell, SD 57301
Phone (605) 995-6477
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 10652 | SD | Yes |
Addresses
Primary practice location
500 S Ohlman St
Mitchell, SD 57301-3109
Mailing address
525 N Foster St
Mitchell, SD 57301-2966
Phone (605) 995-5200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0151182 | Medicaid | SD |
Other names
- Avera Brady Health and Rehab
Other providers in Mitchell, SD
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
- Avera Queen of Peace
All providers in Mitchell, SD · Skilled Nursing Facility in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 20, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.