NPIMap

Organization Active NPI

Bowdle Hospital

Doing business as Bowdle Nursing Home

  • Skilled Nursing Facility
  • Bowdle, SD
National Provider Identifier
1174610505
Registry record updated Dec 29, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
BOWDLE HOSPITAL
Doing business as
Bowdle Nursing Home
Practice address
8001 West 5TH Street
Bowdle, SD 57428-0556
Phone
(605) 285-6391
Fax
(605) 285-6257
NPI assigned
Oct 6, 2006
Last updated
Dec 29, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2009

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

Authorized official

Name
Mr. Jon Kosiak
Title
Ceo
Phone
(605) 285-6391

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

8001 West 5TH Street
Bowdle, SD 57428-0556

Mailing address

P.O. Box 556
Bowdle, SD 57428-0556
Phone (605) 285-6391

Other identifiers 1

IdentifierTypeStateIssuer
0151130MedicaidSD

Other names 1

  • Bowdle Nursing Home Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040325001225 SD Part B Supplier - Clinic/Group Practice 9335056902 Receives reassigned benefits from 6 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bowdle, SD
O20040430001021 SD Part A Provider - Skilled Nursing Facility 9335056902 Practice locations: Bowdle, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174610505. Details of each certification follow.

Skilled nursing facility certification: CCN 435107

Legal name
BOWDLE HOSPITAL
Doing business as
BOWDLE NURSING HOME
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 1, 1997
Last certification
Feb 8, 2024
Beds
27
Ownership / control type
City
Organization structure
CorporationNon-profit
Incorporated
Dec 22, 2003 in SD
Enrollment address
8001 W 5TH St
Bowdle, SD 57428
Nursing home name
BOWDLE NURSING HOME

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 4

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Bowdle Nursing HomeCCN 435107 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Government - City
Certified
Sep 1, 1997
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
2723.3 residents per day on average

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
43D2190609Bowdle Nursing Home8001 W 5TH Street, Bowdle, SD 57428Certificate of waiverAug 16, 2026

National Provider Directory

National Provider Directory
Tax ID family
Bowdle Hospital5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Russell Maier Individual Corporate DirectorBoard Member May 1, 2023
City of Bowdle Organization, Bowdle, SD 5% Or Greater Direct Ownership Interest Feb 1, 1987 100%
Darryn Barnhardt Individual Corporate DirectorBoard Member Sep 1, 2022
Lacey L Kessler Individual W-2 Managing EmployeeMD; Aug 21, 2017
Operational/Managerial Control Nov 19, 2024
Adp of the SNF Dec 10, 2024
Margaret Bobby Individual Corporate DirectorBoard Member May 1, 2022
Amber Shaykett Individual Corporate DirectorBoard Member Sep 1, 2022
Darwyn Kleffman Individual Corporate OfficerCeo May 20, 2019
W-2 Managing EmployeeAd; May 20, 2019
Operational/Managerial Control Nov 19, 2024
Adp of the SNF Dec 10, 2024
Michael Gunderson Individual Corporate DirectorBoard Member May 1, 2017
Rick Boschee Individual Corporate DirectorChairman of the Board May 1, 2000 100%
Rex Gab Individual Corporate DirectorBoard Member Sep 1, 2022

Owners & managing parties with NPI records 1

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

  • Lacey Kessler, MD
    • Family Medicine Physician
    • Bowdle, SD
    • NPI 1508279738

    Adp of the SNF, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Practitioners 2

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 2

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": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262044800000",
    "number": "1174610505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 556",
            "city": "BOWDLE",
            "state": "SD",
            "postal_code": "574280556",
            "telephone_number": "605-285-6391",
            "fax_number": "605-285-6391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8001 WEST 5TH STREET",
            "city": "BOWDLE",
            "state": "SD",
            "postal_code": "574280556",
            "telephone_number": "605-285-6391",
            "fax_number": "605-285-6257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOWDLE HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2009-12-29",
        "status": "A",
        "authorized_official_last_name": "KOSIAK",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "605-285-6391",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0151130",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bowdle Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bowdle, SD

Sources for this page

Verify at the official NPI Registry.