NPIMap

Organization Active NPI

Monument Health Network, Inc.

Doing business as Monument Health Lead-Deadwood Hospital

  • Critical Access Hospital
  • Deadwood, SD
National Provider Identifier
1174590806
Registry record updated May 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
10535 Issued in SD
Legal business name
MONUMENT HEALTH NETWORK, INC.
Doing business as
Monument Health Lead-Deadwood Hospital
Practice address
61 Charles St
Deadwood, SD 57732-1303
Phone
(605) 717-6000
Fax
(605) 717-6008
NPI assigned
Mar 1, 2006
Last updated
May 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2022

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

Authorized official

Name
Mark C Schmidt
Title
President Custer LD-DWD Hospital
Phone
(605) 717-6020

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 10535 SD Primary
Ambulance 341600000X 10535 SD
Land Ambulance 3416L0300X

Addresses

Primary practice location

61 Charles St
Deadwood, SD 57732-1303

Mailing address

PO Box 860013
Minneapolis, MN 55486-0013
Phone (605) 717-6000

Other names 1

  • Monument Health Lead-Deadwood Hospital Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20061104000564 SD Part A Provider - Critical Access Hospital 5991616427 Receives reassigned benefits from 39 practitioners
1 other NPI on this enrollment
Practice locations: Deadwood, SD
O20070125000097 SD Part A Provider - Critical Access Hospital 5991616427 1 other NPI on this enrollment
Practice locations: Deadwood, SD

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1174590806. Details of each certification follow.

Hospital certification: CCN 431320

Legal name
MONUMENT HEALTH NETWORK INC
Doing business as
MONUMENT HEALTH LEAD-DEADWOOD HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
May 1, 2001
Last certification
Jun 6, 2024
Beds
18
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jan 14, 1981 in SD
Enrollment address
61 Charles St
Deadwood, SD 57732-1303

Hospital certification: CCN 43Z320

Legal name
MONUMENT HEALTH NETWORK INC
Doing business as
MONUMENT HEALTH LEAD-DEADWOOD HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Jan 14, 1981 in SD
Enrollment address
61 Charles St
Deadwood, SD 57732-1303

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Monument Health Lead-Deadwood HospitalCCN 431320 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Family Medical Center M44 organizations share this tax ID, including this one

Other organizations with this tax ID 43

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

View all 43

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Ruta P Davidson Individual Corporate OfficerPresident & Ceo Aug 18, 2018 100%
Corporate DirectorPresident/Ceo Aug 18, 2018
W-2 Managing EmployeePresident/Ceo Aug 18, 2018 100%
Operational/Managerial ControlPresident/Ceo Aug 18, 2018 100%
Corporate Officer Aug 18, 2018 100%
Thomas S Worsley Individual Corporate Director Jul 27, 2018
Operational/Managerial ControlPresident, Hills Market Jul 27, 2018 75%
Corporate Director Mar 1, 2018
W-2 Managing Employee Aug 17, 2015 75%
Operational/Managerial Control Mar 1, 2018 75%
Kenneth Meirose Individual Corporate Director Aug 26, 2021
Scott Sabers Individual Corporate DirectorBoard Member Jan 26, 2021
Corporate Director Aug 26, 2021
Austin M Willuweit Individual Corporate OfficerChief Financial Officer Mar 2, 2025
W-2 Managing EmployeeChief Financial Officer May 9, 2016 50%
Operational/Managerial ControlChief Financial Officer Mar 2, 2025 50%
Mark C Schmidt Individual Corporate Officer#Name? Jun 1, 2017 75%
W-2 Managing EmployeePresident Lead Deadwood Market Jun 1, 2015 25%
Operational/Managerial ControlPresident Lead Deadwood Market Jun 1, 2015 25%
Corporate Officer Jun 1, 2015 75%
W-2 Managing EmployeePresident Lead Deadwood Market Jun 1, 2015 75%
Monument Health Inc Organization, Rapid City, SD Corporation, Non-profit Operational/Managerial Control Jul 1, 2005 100%
Kathryn Johnson Individual Corporate DirectorBoard Member Jul 1, 2020
Corporate Director Jul 1, 2020
Heather a Brewer Individual Corporate Director Jul 1, 2020
Jason L Knudson Individual Corporate Director Jul 1, 2021
Steven K Williams Individual Corporate DirectorBoard Member Oct 22, 2019
Dan Leikvold Individual Corporate DirectorBoard Member Jul 1, 2020
Corporate Director Jul 1, 2020

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Hans P Peterson Memorial HospitalPhilip, SD, CCN 431319 Hospital Operational/Managerial Control Oct 1, 2011
Hans P Peterson Memorial HospitalPhilip, SD, CCN 43Z319 Hospital Operational/Managerial Control Jan 1, 2021

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 15

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

View all 15

Practitioners & affiliated clinicians

Practitioners 40

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 40

Affiliated clinicians 107

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 107

NPI Registry JSON

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

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652313600000",
    "number": "1174590806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860013",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554860013",
            "telephone_number": "605-717-6000",
            "fax_number": "605-717-6008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 CHARLES ST",
            "city": "DEADWOOD",
            "state": "SD",
            "postal_code": "577321303",
            "telephone_number": "605-717-6000",
            "fax_number": "605-717-6008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONUMENT HEALTH NETWORK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-01",
        "last_updated": "2022-05-12",
        "certification_date": "2022-05-12",
        "status": "A",
        "authorized_official_last_name": "SCHMIDT",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT CUSTER LD-DWD HOSPITAL",
        "authorized_official_telephone_number": "605-717-6020"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "SD",
            "license": "10535",
            "primary": true
        },
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "SD",
            "license": "10535",
            "primary": false
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Monument Health Lead-Deadwood Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Monument Health Lead-Deadwood Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Deadwood, SD

Sources for this page

Verify at the official NPI Registry.