NPIMap

Organization Active NPI

Avera Queen of Peace

Doing business as Avera Brady Health and Rehab

  • Skilled Nursing Facility
  • Mitchell, SD
National Provider Identifier
1144225129
Registry record updated Aug 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
10652 Issued in SD
Legal business name
AVERA QUEEN OF PEACE
Doing business as
Avera Brady Health and Rehab
Practice address
500 S Ohlman St
Mitchell, SD 57301-3109
Phone
(605) 996-7701
NPI assigned
Jun 16, 2005
Last updated
Aug 20, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
AVERA QUEEN OF PEACEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 20, 2020

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

Authorized official

Name
Douglas Ekeren
Title
President/Ceo
Phone
(605) 668-8322

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 10652 SD Primary

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 names 1

  • Avera Brady Health and Rehab Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091209000245 SD Part A Provider - Skilled Nursing Facility 9335050806 Practice locations: Mitchell, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144225129. Details of each certification follow.

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
CorporationNon-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

Other NPIs with the same Medicare PAC ID 11

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Avera Brady Health and RehabCCN 435061 · All quality measures
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
ActiveFrom the Provider of Services file
Certified beds
8475.2 residents per day on average
Chain
Avera Health13 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
43D0683775Avera Brady Health & Rehab500 South Ohlman, Mitchell, SD 57301Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Donald Kougl MD29 organizations share this tax ID, including this one
Part of
Donald Kougl MD

Other organizations with this tax ID 28

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

View all 28

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
James Francis Dover Individual Corporate OfficerFache, President/Ceo Avera Health Oct 23, 2023
Trevor Dierks Individual Managing Control - Governing BodyBoard Member Jul 1, 2023
Lucio N Margallo Individual Corporate DirectorMedical Director Jul 1, 2020
Operational/Managerial Control Jul 1, 2020
Adp of the SNF Feb 12, 2026
Brad Zomer Individual Managing Control - Governing BodyBoard Member Jul 1, 2018
Diane Sandhoff Individual Managing Control - Governing BodyBoard Member Jul 1, 2023
Fredel Thomas Individual Managing Control - Governing BodyBoard Member Jul 1, 2024
Kimberly Jane Longe Individual Corporate OfficerAdministrator Jun 1, 2024
Operational/Managerial Control Jun 1, 2024
Adp of the SNF Feb 12, 2026
Ryan Thompson Individual Managing Control - Governing BodyBoard Member Jul 1, 2018
Joyce Feteral Individual Managing Control - Governing BodyBoard Member Jul 1, 2024
Organization, Fargo, ND Consulting firm, For-profit General Partnership Interest Dec 1, 2000
Limited Partnership Interest Dec 1, 2000
Adp of the SNF Feb 12, 2026
Vicky Larson Individual Managing Control - Governing BodyBoard Member Jul 1, 2024
Ann Buckmiller Individual Managing Control - Governing BodyBoard Member Jul 1, 2025
Jennifer L Tegethoff Individual Managing Control - Governing BodyBoard Member Jul 1, 2021
Julie Lautt Individual Corporate OfficerCfo Mar 1, 2020
Hilary Rae Rockwell Individual Corporate OfficerPresident/Ceo Jul 1, 2023
Operational/Managerial Control Jul 1, 2023
Mark Puetz Individual Managing Control - Governing BodyBoard Member Jul 1, 2023
Avera Health Organization, Sioux Falls, SD Non-profit, Chain home office 5% Or Greater Direct Ownership Interest Jul 1, 2009 100%
Darlene Bergeleen Individual Managing Control - Governing BodyBoard Member Jul 1, 2023
Jessica a Claussen Individual Managing Control - Governing BodyBoard Member Jul 1, 2023
Mark Hunhoff Individual Managing Control - Governing BodyBoard Member Jul 1, 2019
Nicole Stahle Individual Managing Control - Governing BodyBoard Member Jul 1, 2023

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Avera Weskota Memorial Medical CenterWessington Springs, SD, CCN 43Z324 Hospital Operational/Managerial Control Jun 1, 2000

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Avera Queen of Peace

    dba Avera Weskota Memorial Medical Center Swing Bed Program

    • Medicare Defined Swing Bed Hospital Unit
    • Wessington Springs, SD
    • NPI 1942205646

    Operational/Managerial Control

    CMS ownership

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 1

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 10

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": "1118880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597881600000",
    "number": "1144225129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 N FOSTER ST",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573012966",
            "telephone_number": "605-995-5200",
            "fax_number": "605-995-2441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S OHLMAN ST",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573013109",
            "telephone_number": "605-996-7701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA QUEEN OF PEACE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AVERA QUEEN OF PEACE",
        "enumeration_date": "2005-06-16",
        "last_updated": "2020-08-20",
        "certification_date": "2020-08-20",
        "status": "A",
        "authorized_official_last_name": "EKEREN",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "605-668-8322"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "SD",
            "license": "10652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Brady Health and Rehab",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avera Brady Health and Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mitchell, SD

Sources for this page

Verify at the official NPI Registry.