Monument Health Network. Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

10610 Issued in SD

Legal business name

MONUMENT HEALTH NETWORK. INC.

Doing business as

Monument Health Custer Care Center

Practice address

1065 Montgomery St
Custer, SD 57730-1304

Phone

(605) 673-2237

Fax

(605) 673-3593

NPI assigned

Jun 27, 2005

Last updated

Mar 16, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mark Schmidt

Title

President Custer LD-DWD Markets

Phone

(605) 717-6020

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Monument Health Custer Care Center Doing business as

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386640126. Details of each certification follow.

• CCN 43Z323 Hospital · Details

Hospital certification: CCN 43Z323

Legal name

MONUMENT HEALTH NETWORK INC

Doing business as

MONUMENT HEALTH CUSTER HOSPITAL

Organization structure

CorporationNon-profit

Incorporated

Jan 14, 1981 in SD

Enrollment address

1220 Montgomery St
Custer, SD 57730-1705

Related certifications (CCN) 2

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

• Monument Health Network, Inc

  dba Monument Health Custer Clinic

  • Critical Access Hospital
  • Custer, SD
  • NPI 1871560516

  Unit of hospital

  Provider of Services
• Regional Health Network, Inc.

  dba Hill City Clinic

  • Rural Health Clinic/Center
  • Hill City, SD
  • NPI 1609275908

  Unit of hospital

  Provider of Services

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Monument Health Network, Inc.

  dba Custer Regional Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Custer, SD
  • NPI 1205803160

  O20070125000323

  Same enrollment

All disclosed owners & managing parties 11

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

Owners & managing parties with NPI records 2

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

• Heather A Brewer, MD

  • Obstetrics & Gynecology Physician
  • Spearfish, SD
  • NPI 1134160591

  Corporate Director

  CMS ownership
• Jason Knudson, MD

  • Family Medicine Physician
  • Spearfish, SD
  • NPI 1265405864

  Corporate Director

  CMS ownership

Affiliated clinicians 4

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

• Lisa B Brown, MD

  • Family Medicine Physician
  • Custer, SD
  • NPI 1831161413

  Nursing home

  Care Compare affiliation
• Louise Belle Halbleib, D.O.

  • Family Medicine Physician
  • Custer, SD
  • NPI 1780118448

  Nursing home

  Care Compare affiliation
• Jamie Lynn Roder, CNP

  • Family Nurse Practitioner
  • Rapid City, SD
  • NPI 1265943948

  Nursing home

  Care Compare affiliation
• Avery Lyne Sides, M.D.

  • Family Medicine Physician
  • Hot Springs, SD
  • NPI 1629360342

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1119830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584316800000",
    "number": "1386640126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860013",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554860013",
            "telephone_number": "605-717-6020",
            "fax_number": "605-755-0694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1065 MONTGOMERY ST",
            "city": "CUSTER",
            "state": "SD",
            "postal_code": "577301304",
            "telephone_number": "605-673-2237",
            "fax_number": "605-673-3593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONUMENT HEALTH NETWORK. INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-27",
        "last_updated": "2020-03-16",
        "certification_date": "2020-03-16",
        "status": "A",
        "authorized_official_last_name": "SCHMIDT",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT CUSTER LD-DWD MARKETS",
        "authorized_official_telephone_number": "605-717-6020"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "SD",
            "license": "10610",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "051283",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK",
            "identifier": "85032",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "85032",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0151283",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Monument Health Custer Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Monument Health Custer Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Monument Health Network, Inc (Monument Health Custer Clinic)
• Monument Health Network, Inc. (Custer Regional Hospital)
• Monument Health Network, Inc. (Monument Health Custer Clinic)
• Monument Health Network, Inc. (Monument Health Custer Clinic)
• Monument Health Network, Inc. (Monument Health Birth To Three)
• New Trails Ministry
• Ann Parsells, MA, CCC-SLP
• Nancy Nicole Peterson, LPC-MH
• Pamela Marie Peterson, RN
• Roni Petik, RPT

• Skilled Nursing Facility in Custer, SD
• Providers in Custer, SD by specialty
• Skilled Nursing Facility in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2020; 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.

Verify at the official NPI Registry.