Monument Health Rapid City Hospital, Inc.
Organization Active NPI Rural Health Clinic/Center · Wall, SD
NPI 1457730673 · NPPES record last updated Mar 16, 2020
Key facts
- NPI
- 1457730673
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- MONUMENT HEALTH RAPID CITY HOSPITAL, INC.
- Practice address
- 112 7TH Avenue
Wall, SD 57790-0001 - Phone
- (605) 279-2149
- Fax
- (605) 279-1027
- NPI assigned
- May 20, 2015
- Organization subpart
- No
Authorized official
- Name
- John Pierce
- Title
- Monument Health President
- Phone
- (605) 755-8162
Owners & managing parties with NPI records 3
Owned or controlled facilities with NPI records 8
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 24
Facilities with the same owner 15
Practitioners 560
-
Michael J Aanderud, PA-C
-
Kyle Alan Adams, D.O.
-
Shakeel Ahmed, MD
-
Danielle Rae Akason, PMHNP
-
Bayan Al Share, MD
-
Marc N Aldrich, MD
-
Fawzi Mohammad Ameer, M.D.
-
Megan Mae Anderson, CRNA
-
Ashley Anziano, PA-C
-
Doreen Aryee, MD
-
Justine Ashokar, PH.D.
-
Karmela L Bachman, PA-C
-
Anurag Bajaj, M.D.
-
Denise Marie Baragar, CNP
-
Christopher P. Barrozo, PA-C
-
Amanda Barry, CNP
-
Morgan Ashley Bates, RN, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SD
Rural health clinic certification: CCN 433802
- Legal name
- MONUMENT HEALTH RAPID CITY HOSPITAL INC
- Doing business as
- MONUMENT HEALTH WALL CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Mar 1, 1978
- Last certification
- Sep 13, 2021
- Ownership / control type
- 1B
- Most recent change of ownership
- Jun 15, 2015 (3 total)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jun 13, 1973 in SD
- Enrollment address
- 112 7TH Avenue
Wall, SD 57790-0001
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| Jacob Matthew Weasel |
Corporate Director |
Jul 1, 2020 | |
| Ruta P Davidson |
Corporate Officer |
Nov 9, 2015 | |
| Corporate Director |
Aug 18, 2018 | ||
| W-2 Managing Employee |
Aug 18, 2018 | 100% | |
| Operational/Managerial Control |
Nov 9, 2015 | 75% | |
| Scott R Barbour |
Corporate Director | Jul 1, 2020 | |
| Jill a Tice |
W-2 Managing Employee |
Jul 25, 2019 | 50% |
| Operational/Managerial Control |
Jul 25, 2019 | 50% | |
| Ester E Johannesen |
W-2 Managing Employee |
Mar 1, 2014 | 25% |
| Bradley J Archer |
Corporate Director |
Jul 1, 2018 | |
| W-2 Managing Employee |
Jul 1, 2018 | 75% | |
| Operational/Managerial Control |
Jul 1, 2018 | 75% | |
| John Y Pierce |
Corporate Director |
Sep 18, 2018 | |
| W-2 Managing Employee |
Sep 18, 2018 | 75% | |
| Operational/Managerial Control |
Sep 18, 2018 | 75% | |
| Nicole L Kerkenbush |
W-2 Managing Employee |
Aug 22, 2016 | 50% |
| Operational/Managerial Control |
Aug 22, 2016 | 50% | |
| Dusty J Pinske |
Corporate Director |
Jul 1, 2020 | |
| Austin M Willuweit |
W-2 Managing Employee |
May 9, 2016 | 50% |
| Operational/Managerial Control |
May 9, 2016 | 50% | |
| Srinivas K. Gangineni |
Corporate Director |
Jul 1, 2017 | |
| Monument Health Inc |
Operational/Managerial Control | Jul 1, 2005 | 100% |
| Daryl L Reinicke |
Corporate Director |
Jun 27, 2019 | |
| Deidre N Budahl |
Corporate Director |
Jul 1, 2015 | |
| Ross W McKie |
Corporate Director |
Jun 27, 2019 | |
| Michael J Statz |
Corporate Director |
Jun 27, 2019 | |
| Thomas a Rau |
Operational/Managerial Control |
Jul 1, 2018 | 75% |
All facility ownership & control disclosures 9
| Facility | Type | Role | Since |
|---|---|---|---|
| Same Day Surgery Center LLC |
Hospital | 5% Or Greater Direct Ownership Interest (40%) 5% Or Greater Mortgage Interest (100%) |
Nov 25, 1997 Jul 1, 2001 |
| Rehabilitation and Critical Care Hospital of the Black Hills |
Hospital | 5% Or Greater Indirect Ownership Interest (49%) | Jan 24, 2022 |
| Rehabilitation and Critical Care Hospital of the Black Hills |
Hospital | 5% Or Greater Indirect Ownership Interest (49%) | Jan 24, 2022 |
| Monument Health Care Center |
Skilled nursing facility | Adp of the SNF | Jul 1, 2005 |
| Monument Health Home Plus Home Health |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2016 |
| Monument Health Home Plus Home Health |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2016 |
| Monument Health Home Plus Hospice |
Hospice | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2016 |
| Monument Health Home Plus Hospice |
Hospice | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 2016 |
| Kadoka Clinic |
Rural health clinic | Operational/Managerial Control | Apr 1, 1986 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160308000849 | SD | Part a Provider - Rural Health Clinic | 6002729506 | Practice locations: Wall, SD |
National Provider Directory
- Tax ID family
- Massa Berry Clinic
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
112 7TH Avenue
Wall, SD 57790-0001
Mailing address
PO Box 860013
Minneapolis, MN 55486-0013
Phone (605) 279-2149
Other names
- Monument Health Wall Clinic
- WALL REGIONAL MEDICAL CLINIC
Other providers in Wall, SD
- City of Wall
- Crystal Kay Deal
- Cynthia Sue Dinger
- Eastern Pennington County Ambulance District Inc
- Monument Health Rapid City Hospital, Inc.
- David Orla Olson
- Rapid City Regional Hospital Inc
- Rapid City Regional Hospital, Inc.
- Regional Health Physicians Inc
- Regional Health Physicians, Inc.
All providers in Wall, SD · Rural Health Clinic/Center in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 16, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.