NPIMap

Organization Active NPI

Avera McKennan

  • Critical Access Hospital
  • Flandreau, SD
National Provider Identifier
1295747608
Registry record updated Oct 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
10540 Issued in SD
Legal business name
AVERA MCKENNAN
Practice address
214 N Prairie St
Flandreau, SD 57028-1243
Phone
(605) 997-2433
Fax
(605) 997-3611
NPI assigned
Aug 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2023

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

Authorized official

Name
Ronald Joseph Place, MD
Title
President/Ceo
Phone
(605) 322-7903

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 10540 SD Primary

Addresses

Primary practice location

214 N Prairie St
Flandreau, SD 57028-1243

Mailing address

PO Box 5045 Attn Prvenrolmt Palm Place BLDG
Sioux Falls, SD 57117-5045
Phone (605) 322-6428

Other identifiers 14

IdentifierTypeStateIssuer
0587261MedicaidIA
1295747608MedicaidWY
80484900MedicaidWI
5500412MedicaidSD
0100412MedicaidSD
10025183900MedicaidNE
1778HFLOtherMNMN BLUE CROSS PROV#
192355200MedicaidMN
01592MedicaidND
4103188MedicaidMT
00B2896MedicaidNM
202619MedicaidAZ
1295747608MedicaidMI
81310OtherSDSD BLUE CROSS HOSP PROV#

Other names 1

  • Avera Flandreau Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061104000296 SD Part A Provider - Critical Access Hospital 0345157103 Receives reassigned benefits from 33 practitioners
Practice locations: Flandreau, SD

Hospital certification: CCN 431310

Legal name
AVERA MCKENNAN
Doing business as
AVERA FLANDREAU HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jan 1, 1999
Last certification
Mar 15, 2023
Beds
18
Ownership / control type
Private (not for profit)
Most recent change of ownership
May 1, 1999 (1 total)
Organization structure
OtherNon-profit
Incorporated
May 23, 1925 in SD
Enrollment address
214 N Prairie St
Flandreau, SD 57028-1243

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

All disclosed owners & managing parties 22

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

NameRoleSinceShare
Alisa L Reindl Individual Corporate DirectorBoard Member Jul 1, 2021
Tamera L Sturm Individual Corporate DirectorBoard Member Jul 1, 2025
Van Fishback Individual Corporate DirectorBoard Member Jul 1, 2018
Candyce C Chrystal Individual Corporate DirectorBoard Member Jul 1, 2023
Harriet Yocum Individual Corporate DirectorBoard Member Jul 1, 2021
Jennifer Bunkers Individual Corporate DirectorBoard Member Jul 1, 2021
Randy Knecht Individual Corporate DirectorBoard Member Jul 1, 2018
Jawad Nazir Individual Corporate DirectorBoard Member Jul 1, 2020
Lucille F Welbig Individual Corporate Officer Jul 1, 2014
Joseph Patrick Costello Individual Corporate DirectorBoard Member Jul 1, 2017
Sanaa Abourezk Individual Corporate DirectorBoard Member Jul 1, 2024
Lindsay Flannery Individual W-2 Managing Employee Jun 23, 2008
Amanda Marie Schutz Individual Corporate OfficerOfficer Billing Services Jun 1, 2018
Ryan Boschee Individual Corporate DirectorBoard Member Jul 1, 2024
Jennifer Kirby Individual Corporate DirectorBoard Member Jul 1, 2020
Ronald J. Place Individual Corporate OfficerPresident/Ceo Jun 5, 2023
Operational/Managerial Control Jun 5, 2023
Julie Lautt Individual Corporate OfficerCfo Mar 1, 2020
Mary C Curran Individual Corporate DirectorBoard Member Jul 1, 2018
Avera Health Organization, Sioux Falls, SD Non-profit 5% Or Greater Direct Ownership Interest Jun 15, 1992 100%
Operational/Managerial Control Jun 15, 1992
Roxanne P Seifert Individual Corporate DirectorBoard Member Jul 1, 2022
Cristina a Hill Jensen Individual Corporate DirectorBoard Member Jul 1, 2018
Benjamin M Solomon Individual Corporate DirectorBoard Member Jul 1, 2022

All facility ownership & control disclosures 9

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

FacilityTypeRoleSince
Lakes Regional HealthcareSpirit Lake, IA, CCN 160124 Hospital Operational/Managerial Control Oct 24, 2022
Avera Heart Hospital of South DakotaSioux Falls, SD, CCN 430095 Hospital 5% Or Greater Direct Ownership Interest (33.33%) Oct 1, 2010
Avera Holy Family HospitalEstherville, IA, CCN 161351 Hospital Operational/Managerial Control Oct 6, 1994
Avera Holy Family HospitalEstherville, IA, CCN 16Z351 Hospital Operational/Managerial Control Jan 1, 2007
Lakes Regional HealthcareSpirit Lake, IA, CCN 16U124 Hospital Operational/Managerial Control Oct 24, 2022
United Living CommunityBrookings, SD, CCN 435079 Skilled nursing facility Operational/Managerial Control Nov 15, 2005
Freeman Regional Health ServicesMenno, SD, CCN 433444 Rural health clinic 5% Or Greater Direct Ownership Interest (50%) May 1, 2011
Freeman Regional Health ServicesBridgewater, SD, CCN 433443 Rural health clinic 5% Or Greater Direct Ownership Interest (50%) May 1, 2011
Freeman Regional Health ServicesMarion, SD, CCN 433445 Rural health clinic 5% Or Greater Direct Ownership Interest (50%) May 1, 2011

National Provider Directory

National Provider Directory
Tax ID family
Avera McKennan Hosp105 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Owners & managing parties with NPI records 5

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

Facilities with the same owner 90

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

View all 90

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 33

Affiliated clinicians 29

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

View all 29

Care Compare: Hospital

Medicare Care Compare
Listed as
Avera Flandreau Hospital - CahCCN 431310
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

NPI Registry JSON

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1295747608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5045 ATTN PRVENROLMT PALM PLACE BLDG",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175045",
            "telephone_number": "605-322-6428",
            "fax_number": "605-322-6499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 N PRAIRIE ST",
            "city": "FLANDREAU",
            "state": "SD",
            "postal_code": "570281243",
            "telephone_number": "605-997-2433",
            "fax_number": "605-997-3611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA MCKENNAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-13",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A",
        "authorized_official_last_name": "PLACE",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "605-322-7903",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "SD",
            "license": "10540",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0587261",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295747608",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "80484900",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5500412",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0100412",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025183900",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN BLUE CROSS PROV#",
            "identifier": "1778HFL",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "192355200",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01592",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4103188",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00B2896",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "202619",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295747608",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SD BLUE CROSS HOSP PROV#",
            "identifier": "81310",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Flandreau Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avera Flandreau Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Flandreau, SD

Sources for this page

Verify at the official NPI Registry.