NPIMap

Organization Active NPI

Presbyterian Retirement Village of Rapid City, Inc.

  • Skilled Nursing Facility
  • Rapid City, SD
National Provider Identifier
1366412348
Registry record updated Jan 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
10666 Issued in SD
Legal business name
PRESBYTERIAN RETIREMENT VILLAGE OF RAPID CITY, INC.
Doing business as
Clarkson Health Care
Practice address
1015 Mountain View Rd
Rapid City, SD 57702-3421
Phone
(605) 343-5882
Fax
(605) 348-5787
NPI assigned
Jan 24, 2006
Organization subpart
Yes
Parent organization
PRESBYTERIAN RETIREMENT VILLAGE OF RAPID CITY, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 20, 2016

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

Authorized official

Name
Daryl Reinicke
Title
Ceo
Phone
(605) 343-5882

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 10666 SD Primary

Addresses

Primary practice location

1015 Mountain View Rd
Rapid City, SD 57702-3421

Mailing address

1015 Mountain View Rd
Rapid City, SD 57702-3421
Phone (605) 343-5882

Other identifiers 1

IdentifierTypeStateIssuer
0151072MedicaidSD

Other names 1

  • Clarkson Health Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090224000640 SD Part A Provider - Skilled Nursing Facility 3476618539 Practice locations: Rapid City, SD

Skilled nursing facility certification: CCN 435037

Legal name
PRESBYTERIAN RETIREMENT VILLAGE OF RAPID CITY, INC.
Doing business as
CLARKSON HEALTH CARE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 1988
Last certification
Feb 1, 2024
Beds
49
Ownership / control type
Other Nonprofit
Organization structure
CorporationNon-profit
Incorporated
May 14, 1979 in SD
Enrollment address
1015 Mountain View Rd
Rapid City, SD 57702-3421
Nursing home name
CLARKSON HEALTH CARE

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Clarkson Health CareCCN 435037 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Other
Certified
Jan 1, 1988
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
4945.5 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
43D0658960Clarkson Health Care1015 Mountain View Road, Rapid City, SD 57702Certificate of waiverJul 14, 2028

National Provider Directory

National Provider Directory
Tax ID family
Presbyterian Retirement Village of Rapid City Inc4 organizations share this tax ID, including this one
Part of
Presbyterian Retirement Village of Rapid City Inc

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Mark Harlow Individual Managing Control - Governing BodyBoard Member Apr 28, 2015
Presbyterian Retirement Village of Rapid City, Inc. Organization, Rapid City, SD Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2000 100%
Andrea Knoll Individual Operational/Managerial Control Oct 1, 2019
Adp of the SNF Feb 24, 2025
Deborah K Mudge Individual Managing Control - Governing BodyBoard Member Aug 11, 2008
Bradley J Archer Individual Managing Control - Governing BodyBoard Member Jan 1, 2019
Christopher Kilpatrick Individual Managing Control - Governing BodyBoard Member Jan 1, 2022
Molly Moore Individual Managing Control - Governing BodyBoard Member Jan 1, 2022
Maryann Petrotto Individual Operational/Managerial Control Jun 19, 2014
Craig a Pfeifle Individual Managing Control - Governing BodyBoard Member Aug 11, 2008
Douglas K Jackson Individual Managing Control - Governing BodyBoard Member Apr 28, 2015
Helene Duhamel Duffy Individual Managing Control - Governing BodyBoard Member Jan 1, 2023
Kenneth C Diamond Individual Operational/Managerial Control Jan 1, 2011
Adp of the SNF Mar 12, 2025
Kelsey Bertsch Individual Operational/Managerial Control Apr 4, 2022
Adam Knudson Individual Managing Control - Governing BodyBoard Member Jan 1, 2025
Kassie Shiffermiller Individual Managing Control - Governing BodyBoard Member Jan 1, 2023
Tyler Donohue Individual Corporate OfficerCeo Jun 12, 2023
Operational/Managerial Control Jun 12, 2023
Michael Pogany Individual Managing Control - Governing BodyBoard Member Jan 1, 2023
Leah Bifulco Individual Corporate OfficerChief Financial Officer Oct 17, 2016
Operational/Managerial Control Oct 17, 2016

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Westhills Village Health CareRapid City, SD, CCN 435033 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF		 May 14, 1979
May 14, 1979

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

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

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": "1138060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453248000000",
    "number": "1366412348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 MOUNTAIN VIEW RD",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577023421",
            "telephone_number": "605-343-5882",
            "fax_number": "605-348-5787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 MOUNTAIN VIEW RD",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577023421",
            "telephone_number": "605-343-5882",
            "fax_number": "605-348-5787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN RETIREMENT VILLAGE OF RAPID CITY, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRESBYTERIAN RETIREMENT VILLAGE OF RAPID CITY, INC",
        "enumeration_date": "2006-01-24",
        "last_updated": "2016-01-20",
        "status": "A",
        "authorized_official_last_name": "REINICKE",
        "authorized_official_first_name": "DARYL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "605-343-5882"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "SD",
            "license": "10666",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0151072",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clarkson Health Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rapid City, SD

Sources for this page

Verify at the official NPI Registry.