NPIMap

Organization Active NPI

Mobridge Regional Hospital

Doing business as Swingbed

  • Medicare Defined Swing Bed Hospital Unit
  • Mobridge, SD
National Provider Identifier
1184766073
Registry record updated Oct 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
48404 Issued in SD
Legal business name
MOBRIDGE REGIONAL HOSPITAL
Doing business as
Swingbed
Practice address
1401 10TH Ave W
Mobridge, SD 57601-0580
Phone
(605) 845-3692
Fax
(605) 845-8252
NPI assigned
Feb 14, 2007
Last updated
Oct 29, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2019

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

Authorized official

Name
Renae Tisdall
Title
Cfo
Phone
(605) 845-8164

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 48404 SD Primary
Critical Access Hospital 282NC0060X 48404 SD

Addresses

Primary practice location

1401 10TH Ave W
Mobridge, SD 57601-0580

Mailing address

1401 10TH Ave W
PO Box 580
Mobridge, SD 57601-0580
Phone (605) 845-3692

Other identifiers 1

IdentifierTypeStateIssuer
0159400MedicaidSD

Other names 1

  • Swingbed Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120306000325 SD Part A Provider - Critical Access Hospital 6507776135 Practice locations: Mobridge, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184766073. Details of each certification follow.

Hospital certification: CCN 43Z325

Legal name
MOBRIDGE REGIONAL HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
May 20, 1953 in SD
Enrollment address
1401 10TH Ave W
Mobridge, SD 57601-1106
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Mobridge Comm Hosp Ee9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Renae Karst Individual Corporate OfficerCfo Aug 16, 2016
Corporate Director Aug 16, 2016
W-2 Managing Employee Aug 16, 2016
Travis B Henderson Individual Corporate Director Jan 15, 2011
Kristi Kraft Individual W-2 Managing Employee Aug 16, 2016
Christopher Bohlander Individual Corporate Director Jan 1, 2018
Joshua Wudel Individual Corporate Director Jan 27, 2021
Laurie Bauer Individual Corporate Director Jan 15, 2013
Richard Gross Individual Corporate Director Jan 22, 2020
Adam Hayes Individual Corporate Director Jan 22, 2020
Heidi a Roshau Individual Corporate Director Jan 15, 2011
Patricia Schmeichel Individual Corporate Director Jan 1, 2018
William Bachmeier Individual Corporate DirectorBoard Member Jan 15, 2011
Lori Heil Individual Corporate Director Sep 1, 2014
Duane J Kraft Individual Corporate Director Jan 15, 2010
Robert C Marciano Individual Corporate Director Jan 15, 2010
John Ayoub Individual Corporate Officer Jan 9, 2017
Corporate Director Jan 9, 2017
W-2 Managing Employee Jan 9, 2017

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

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": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572307200000",
    "number": "1184766073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 10TH AVE W",
            "address_2": "PO BOX 580",
            "city": "MOBRIDGE",
            "state": "SD",
            "postal_code": "576010580",
            "telephone_number": "605-845-3692",
            "fax_number": "605-845-8252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 10TH AVE W",
            "city": "MOBRIDGE",
            "state": "SD",
            "postal_code": "576010580",
            "telephone_number": "605-845-3692",
            "fax_number": "605-845-8252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBRIDGE REGIONAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2019-10-29",
        "status": "A",
        "authorized_official_last_name": "TISDALL",
        "authorized_official_first_name": "RENAE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "605-845-8164"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "SD",
            "license": "48404",
            "primary": true
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "SD",
            "license": "48404",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0159400",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Swingbed",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Swingbed",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mobridge, SD

Sources for this page

Verify at the official NPI Registry.