Active NPI
Avera Tyler
- Medicare Defined Swing Bed Hospital Unit
- Tyler, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medicare Defined Swing Bed Hospital Unit
- License
- 380347
- Legal business name
- AVERA TYLER
- Practice address
- 240 Willow Street
Tyler, MN 56178 - Phone
- (507) 247-5521
- Fax
- (507) 247-2325
- NPI assigned
- Dec 22, 2006
- Last updated
- Dec 2, 2022
- Organization subpart
- Yes
- Parent organization
- AVERA MARSHALL
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Debbie Streier
- Title
- Ceo
- Phone
- (507) 537-9160
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | 380347 | MN | Primary |
Addresses
Primary practice location
240 Willow Street
Tyler, MN 56178
Mailing address
240 Willow St
Tyler, MN 56178-1166
Phone (507) 247-5521
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1889EAL | Other | MN | BLUE CROSS |
| 599245100 | Medicaid | MN |
Other names 1
- Avera Tyler Hospital
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070215000805 | MN | Part A Provider - Critical Access Hospital | 9638088537 |
Receives reassigned benefits from 1 practitioner Practice locations: Tyler, MN |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1326102237. Details of each certification follow.
Hospital certification: CCN 24Z348
- Legal name
- AVERA TYLER
- Doing business as
- AVERA TYLER HOSPITAL
- Organization structure
- Corporation
- Incorporated
- Nov 30, 1961 in MN
- Enrollment address
- 240 Willow St
Tyler, MN 56178-1201
Related certifications (CCN) 1
Facilities connected through Provider of Services related, parent or unit certification numbers.
-
dba Avera Tyler Hospital
- Critical Access Hospital
- Tyler, MN
- NPI 1801840517
Unit of hospital
Other NPIs with the same Medicare PAC ID 4
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba Avera Lake Benton Clinic
- Rural Health Clinic/Center
- Lake Benton, MN
- NPI 1003869892
9638088537
-
dba Avera Medical Group Tyler
- Rural Health Clinic/Center
- Tyler, MN
- NPI 1649223439
9638088537
National Provider Directory
National Provider Directory- Tax ID family
- Avera Lake Benton Clinic
- Part of
- Weiner Memorial Med Ctr
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- General Acute Care Hospital
- Tyler, MN
- NPI 1184832891
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
-
dba Avera Marshall Regional Medical Center
- Medicare Defined Swing Bed Hospital Unit
- Marshall, MN
- NPI 1700070430
Member Of
Ownership & related parties
All disclosed owners & managing parties 20
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| James Francis Dover | Corporate Officer | Oct 23, 2023 | |
| Joyce H Strootman | Corporate Director | Jul 1, 2018 | |
| Quentin J Fixen | Corporate Director | Jul 1, 2018 | |
| Jill Vroman | Corporate Director | Jul 1, 2023 | |
| Debra Ann Streier | Corporate Officer | Feb 1, 2021 | |
| George L Jorgenson | Corporate Director | Sep 1, 2008 | |
| Tim O'Leary | Corporate Director | Jul 1, 2023 | |
| Jodelle a Zimmerman | Corporate Director | Jul 1, 2018 | |
| Sharon Hennen | Corporate Director | Jul 1, 2023 | |
| Gregory W Goepferich | Corporate Director | Jul 1, 2020 | |
| Amanda Sieling | Corporate Director | Jul 1, 2018 | |
| Lavonne Annette Koenen | Corporate Director | Jul 1, 2020 | |
| Thomas J Kooiman | Operational/Managerial Control | May 29, 2022 | |
| Avera Marshall | Operational/Managerial Control | Mar 1, 2016 | |
| Laurie J Johansen | Corporate Director | Apr 1, 2011 | |
| Christy Ann Coudron | Corporate Officer | Sep 1, 2020 | |
| Stephen Menzies Crim | Corporate Director | Jul 1, 2019 | |
| Julie Lautt | Corporate Officer | Aug 5, 2023 | |
| Curtis Ronald Louwagie | Corporate Director | Jul 1, 2018 | |
| Avera Health | 5% Or Greater Direct Ownership Interest | Mar 1, 2016 | 100% |
Owners & managing parties with NPI records 17
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
dba Avera@Home Southwest Minnesota
- Home Health Agency
- Marshall, MN
- NPI 1033535547
Operational/Managerial Control
-
dba Avera Dialysis Marshall
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Marshall, MN
- NPI 1154856839
Operational/Managerial Control
-
dba Avera Morningside Heights Care Center
- Skilled Nursing Facility
- Marshall, MN
- NPI 1255329033
Operational/Managerial Control
-
dba Avera Eye Care Dawson
- Optometrist
- Dawson, MN
- NPI 1396513370
Operational/Managerial Control
-
dba Avera Eye Care Tracy
- Optometrist
- Tracy, MN
- NPI 1487958062
Operational/Managerial Control
-
dba Avera Marshall Regional Medical Center
- Critical Access Hospital
- Marshall, MN
- NPI 1568401016
Operational/Managerial Control
-
dba Avera Eye Care Marshall
- Durable Medical Equipment & Medical Supplies
- Marshall, MN
- NPI 1669622031
Operational/Managerial Control
-
dba Avera Marshall Regional Medical Center
- Medicare Defined Swing Bed Hospital Unit
- Marshall, MN
- NPI 1700070430
Operational/Managerial Control
-
dba Avera Marshall Regional Medical Center
- Psychiatric Hospital Unit
- Marshall, MN
- NPI 1750508412
Operational/Managerial Control
-
dba Avera Eye Care Springfield
- Ophthalmology Physician
- Springfield, MN
- NPI 1922316041
Operational/Managerial Control
-
dba Avera Eye Care Canby
- Optometrist
- Canby, MN
- NPI 1952179939
Operational/Managerial Control
-
dba Avera@Home Southwest Minnesota
- Community Based Hospice Care Agency
- Marshall, MN
- NPI 1952727463
Operational/Managerial Control
Facilities with the same owner 91
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba Avera Granite Falls Health Center Swingbed
- Medicare Defined Swing Bed Hospital Unit
- Granite Falls, MN
- NPI 1578106498
Avera Health, Avera Marshall
-
dba Avera Granite Falls Care Center
- Skilled Nursing Facility
- Granite Falls, MN
- NPI 1679116503
Avera Marshall
-
dba Avera Granite Falls Health Center
- Critical Access Hospital
- Granite Falls, MN
- NPI 1700429610
Avera Health, Avera Marshall
-
dba Avera@Home Southwest Minnesota
- Home Health Agency
- Marshall, MN
- NPI 1033535547
Avera Health
-
dba Avera Morningside Heights Care Center
- Skilled Nursing Facility
- Marshall, MN
- NPI 1255329033
Avera Health
-
dba Avera Marshall Regional Medical Center
- Critical Access Hospital
- Marshall, MN
- NPI 1568401016
Avera Health
-
dba Avera Marshall Regional Medical Center
- Medicare Defined Swing Bed Hospital Unit
- Marshall, MN
- NPI 1700070430
Avera Health
-
dba Avera Marshall Regional Medical Center
- Psychiatric Hospital Unit
- Marshall, MN
- NPI 1750508412
Avera Health
-
dba Avera@Home Southwest Minnesota
- Community Based Hospice Care Agency
- Marshall, MN
- NPI 1952727463
Avera Health
-
dba Avera Lake Benton Clinic
- Rural Health Clinic/Center
- Lake Benton, MN
- NPI 1003869892
Avera Health, Avera Marshall
-
dba Avera Medical Group Tyler
- Rural Health Clinic/Center
- Tyler, MN
- NPI 1649223439
Avera Health, Avera Marshall
-
dba Avera Tyler Hospital
- Critical Access Hospital
- Tyler, MN
- NPI 1801840517
Avera Health, Avera Marshall
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.
-
- Family Nurse Practitioner
- Ivanhoe, MN
- NPI 1629414578
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": "1166745600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1669939200000",
"number": "1326102237",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "240 WILLOW ST",
"city": "TYLER",
"state": "MN",
"postal_code": "561781166",
"telephone_number": "507-247-5521",
"fax_number": "507-247-2325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "240 WILLOW STREET",
"city": "TYLER",
"state": "MN",
"postal_code": "56178",
"telephone_number": "507-247-5521",
"fax_number": "507-247-2325"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AVERA TYLER",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "AVERA MARSHALL",
"enumeration_date": "2006-12-22",
"last_updated": "2022-12-02",
"certification_date": "2022-12-02",
"status": "A",
"authorized_official_last_name": "STREIER",
"authorized_official_first_name": "DEBBIE",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "507-537-9160"
},
"taxonomies": [
{
"code": "275N00000X",
"taxonomy_group": "",
"desc": "Medicare Defined Swing Bed Unit",
"state": "MN",
"license": "380347",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "1889EAL",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "599245100",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Avera Tyler Hospital",
"code": "4",
"type": "Former Legal Business Name"
},
{
"organization_name": "Avera Tyler Hospital",
"code": "4",
"type": "Former Legal Business Name"
}
]
}Other providers in Tyler, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.