NPIMap

Organization Active NPI

Heart Hospital of South Dakota LLC

  • Cardiovascular Disease Physician
  • Sioux Falls, SD
National Provider Identifier
1407109705
Registry record updated Oct 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
41953 Issued in SD
Legal business name
HEART HOSPITAL OF SOUTH DAKOTA LLC
Practice address
4520 W 69TH St
Sioux Falls, SD 57108-8148
Phone
(605) 977-5000
Fax
(605) 977-5377
NPI assigned
Oct 24, 2012
Organization subpart
Yes
Parent organization
HEART HOSPITAL OF SOUTH DAKOTA LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 24, 2012

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

Authorized official

Name
Mr. Jon C Soderholm
Title
President
Phone
(605) 977-7005

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X 41953 SD Primary
Clinical Cardiac Electrophysiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0001X 41953 SD
Interventional Cardiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0011X 41953 SD
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X 41953 SD
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208G00000X 41953 SD

Addresses

Primary practice location

4520 W 69TH St
Sioux Falls, SD 57108-8148

Mailing address

4500 W 69TH St
Sioux Falls, SD 57108-8148
Phone (605) 977-7000

Other names 1

  • NORTH CENTRAL HEART A DIVISION OF AVERA HEART HOSPITAL Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD, IA, MN4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20041103001260 SD Part A Provider - Hospital 5799777249 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sioux Falls, SD
O20121211000268 IA Part B Supplier - Hospital Department(S) 5799777249 Receives reassigned benefits from 35 practitioners
Practice locations: Spencer, IA; Sioux Center, IA; Sibley, IA; Le Mars, IA; Estherville, IA; Orange City, IA
O20130124000368 MN Part B Supplier - Hospital Department(S) 5799777249 Receives reassigned benefits from 31 practitioners
Practice locations: Hendricks, MN; Worthington, MN; Windom, MN; Tyler, MN; Pipestone, MN; Marshall, MN; Dawson, MN
O20130222000000 SD Part B Supplier - Hospital Department(S) 5799777249 Receives reassigned benefits from 65 practitioners
Practice locations: Sioux Falls, SD

Other NPIs with the same Medicare PAC ID 1

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

Hospital certification: CCN 430095

Legal name
HEART HOSPITAL OF SOUTH DAKOTA LLC
Doing business as
AVERA HEART HOSPITAL OF SOUTH DAKOTA
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Mar 22, 2001
Last certification
Mar 20, 2019
Beds
53
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Incorporated
Jun 8, 1999 in NC
Enrollment address
4500 W 69TH St
Sioux Falls, SD 57108-8148
Other Hospital Practice Location
Hospital subgroups
General, Specialty hospital

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Part of
Heart Hospital of South Dakota LLC

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

  • Avera McKennan
    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Mitchell, SD
    • NPI 1023413093

    Member Of

    NPD member

Locations

926 N 8th St
Estherville, IA 51334
Phone (712) 362-3501

345 W Steamboat Dr
North Sioux City, SD 57049
Phone (605) 217-2175

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Avera McKennan Organization, Sioux Falls, SD 5% Or Greater Direct Ownership Interest Oct 1, 2010 33.33%
North Central Heart Institute Organization, Sioux Falls, SD LLC 5% Or Greater Direct Ownership Interest Oct 1, 2010 33.33%
Cheryl J Osmond Individual W-2 Managing EmployeeVice President of Clinical Apr 1, 2004
Michael Eugene Gibbs Individual Corporate Officer May 1, 2017
Corporate Director May 1, 2017
Julie Lautt Individual Operational/Managerial Control Oct 1, 2010
Brian E Pederson Individual Corporate Officer Jun 24, 2019
Corporate Director Jun 24, 2019
Sioux Falls Hospital Management, Inc Organization, Sioux Falls, SD LLC 5% Or Greater Indirect Ownership Interest Oct 1, 2010 33.33%

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 95

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

View all 95

Affiliated clinicians 237

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

View all 237

Care Compare: Hospital

Medicare Care Compare
Listed as
Avera Heart Hospital of South DakotaCCN 430095
Overall star rating
5 of 5
Type
Acute Care Hospitals
Ownership
Proprietary
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": "1351036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351036800000",
    "number": "1407109705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 W 69TH ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571088148",
            "telephone_number": "605-977-7000",
            "fax_number": "605-977-7001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4520 W 69TH ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571088148",
            "telephone_number": "605-977-5000",
            "fax_number": "605-977-5377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEART HOSPITAL OF SOUTH DAKOTA LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HEART HOSPITAL OF SOUTH DAKOTA LLC",
        "enumeration_date": "2012-10-24",
        "last_updated": "2012-10-24",
        "status": "A",
        "authorized_official_last_name": "SODERHOLM",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "605-977-7005",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "SD",
            "license": "41953",
            "primary": true
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "SD",
            "license": "41953",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "SD",
            "license": "41953",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "SD",
            "license": "41953",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "SD",
            "license": "41953",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTH CENTRAL HEART A DIVISION OF AVERA HEART HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.