NPIMap

Organization Active NPI

Mobridge Regional Hospital

  • Rural Health Clinic/Center
  • MC Laughlin, SD
National Provider Identifier
1457328841
Registry record updated Oct 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MOBRIDGE REGIONAL HOSPITAL
Practice address
103 1St Ave East
MC Laughlin, SD 57642-0520
Phone
(605) 823-4253
NPI assigned
Mar 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2016

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

Authorized official

Name
Renae Tisdall
Title
Cfo
Phone
(605) 845-8164

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

103 1St Ave East
MC Laughlin, SD 57642-0520

Mailing address

PO Box 520
MC Laughlin, SD 57642-0520
Phone (605) 823-4253

Other identifiers 1

IdentifierTypeStateIssuer
5300702MedicaidSD

Other names 1

  • West River Health Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030514000034 SD Part A Provider - Rural Health Clinic 6507776135 Practice locations: MC Laughlin, SD

Rural health clinic certification: CCN 433430

Legal name
MOBRIDGE REGIONAL HOSPITAL
Doing business as
WEST RIVER HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 1, 2008
Last certification
Jun 30, 2022
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
May 23, 1953 in SD
Enrollment address
103 1St Ave E
MC Laughlin, SD 57642-0000
Related CCNs
431325

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

Other NPIs with the same Medicare PAC ID 5

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

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
43D0658957West River Health Clinic103 1St Avenue E PO Box 520, McLaughlin, SD 57642Provider-performed microscopyApr 30, 2028

National Provider Directory

National Provider Directory
Tax ID family
Mobridge Medical Clinic9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Renae Karst Individual Corporate OfficerCfo Jan 1, 2011
Corporate Director Aug 16, 2016
Travis B Henderson Individual Corporate DirectorBoard Member Jan 1, 2007
Kristi Kraft Individual W-2 Managing Employee Aug 16, 2016
Christopher Bohlander Individual Corporate Director Jan 1, 2018
Joshua Wudel Individual Corporate Director Jan 27, 2021
Laurie Bauer Individual Corporate Director Jan 27, 2021
Richard Gross Individual Corporate Director Jan 22, 2020
Adam Hayes Individual Corporate Director Jan 22, 2020
Heidi a Roshau Individual Corporate DirectorBoard Member Jan 15, 2011
Patricia Schmeichel Individual Corporate Director Jan 1, 2018
William Bachmeier Individual Corporate DirectorBoard Member Jan 15, 2011
Lori Heil Individual Corporate Director Sep 1, 2014
Duane J Kraft Individual Corporate Director Jan 1, 2006
Robert C Marciano Individual Corporate DirectorBoard Member Jan 1, 2006
John Ayoub Individual Corporate Officer Jan 9, 2017
Corporate Director Jan 9, 2017
W-2 Managing Employee Jan 9, 2017

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1141344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475712000000",
    "number": "1457328841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 520",
            "city": "MC LAUGHLIN",
            "state": "SD",
            "postal_code": "576420520",
            "telephone_number": "605-823-4253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 1ST AVE EAST",
            "city": "MC LAUGHLIN",
            "state": "SD",
            "postal_code": "576420520",
            "telephone_number": "605-823-4253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBRIDGE REGIONAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-03",
        "last_updated": "2016-10-06",
        "status": "A",
        "authorized_official_last_name": "TISDALL",
        "authorized_official_first_name": "RENAE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "605-845-8164"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5300702",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West River Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in MC Laughlin, SD

Sources for this page

Verify at the official NPI Registry.