NPIMap

Organization Active NPI

Platte Community Memorial Hospital Inc

Doing business as Platte Health Center Avera

  • Critical Access Hospital
  • Platte, SD
National Provider Identifier
1346451192
Registry record updated Mar 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
10557 Issued in SD
Legal business name
PLATTE COMMUNITY MEMORIAL HOSPITAL INC
Doing business as
Platte Health Center Avera
Practice address
601 E 7TH St
Platte, SD 57369
Phone
(605) 337-3364
Fax
(605) 337-2670
NPI assigned
May 24, 2007
Last updated
Mar 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2024

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

Authorized official

Name
Mr. Mark Burket
Title
Ceo
Phone
(605) 337-3364

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 10557 SD Primary

Addresses

Primary practice location

601 E 7TH St
Platte, SD 57369

Mailing address

601 E 7TH St
PO Box 200
Platte, SD 57369-2123
Phone (605) 337-3364

Other identifiers 1

IdentifierTypeStateIssuer
0100260MedicaidSD

Other names 1

  • Platte Health Center Avera Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101018000690 SD Part A Provider - Critical Access Hospital 6507770054 Receives reassigned benefits from 1 practitioner
Practice locations: Platte, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346451192. Details of each certification follow.

Hospital certification: CCN 43Z306

Legal name
PLATTE COMMUNITY MEMORIAL HOSPITAL INC
Doing business as
PLATTE HEALTH CENTER
Organization structure
CorporationNon-profit
Incorporated
Dec 5, 1947 in SD
Enrollment address
601 E 7TH St
Platte, SD 57369-2123

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

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Platte Community Mem Hosp7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

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
Ann Johnson Individual Corporate DirectorBoard Member Nov 1, 2019
Dennis Vanderwerff Individual Corporate DirectorPresident Nov 1, 2015
Valerie Kotilinek Individual W-2 Managing EmployeePatient Financial Services Nov 1, 2001
Jill Gustad Individual Corporate DirectorSecretary Nov 1, 2019
Karen Turnis Individual Corporate DirectorBoard Member Nov 1, 2020
Robert Graves Individual Corporate DirectorBoard Member Nov 1, 2018
Brandi Delange Individual Corporate DirectorTreasurer Nov 1, 2018
Mark a Burket Individual Corporate OfficerCeo Aug 1, 1996
Jesse Block Individual Corporate DirectorVice President Nov 1, 2018
Vicki Jensen Individual Corporate OfficerCfo May 24, 2010
Dennis Severson Individual Corporate DirectorBoard Member Nov 1, 2022
Kim Ehlers Individual Corporate DirectorBoard Member Nov 1, 2022

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Platte Medical Clinic AveraPlatte, SD, CCN 433415 Rural health clinic Operational/Managerial Control (100%) Oct 1, 1996
White Lake Medical Clinic AveraWhite Lake, SD, CCN 433439 Rural health clinic Operational/Managerial Control (100%) Jul 1, 2015

Owned or controlled facilities with NPI records 2

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

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.

Affiliated clinicians 3

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": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710115200000",
    "number": "1346451192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 E 7TH ST",
            "address_2": "PO BOX 200",
            "city": "PLATTE",
            "state": "SD",
            "postal_code": "573692123",
            "telephone_number": "605-337-3364",
            "fax_number": "605-337-2670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 E 7TH ST",
            "city": "PLATTE",
            "state": "SD",
            "postal_code": "57369",
            "telephone_number": "605-337-3364",
            "fax_number": "605-337-2670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLATTE COMMUNITY MEMORIAL HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-07",
        "status": "A",
        "authorized_official_last_name": "BURKET",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "605-337-3364",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "SD",
            "license": "10557",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0100260",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Platte Health Center Avera",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Platte, SD

Sources for this page

Verify at the official NPI Registry.