NPIMap

Organization Active NPI

St. Michael's Hospital, Inc.

Doing business as Bon Homme Family Practice

  • Critical Access Hospital Clinic/Center
  • Tyndall, SD
National Provider Identifier
1467496158
Registry record updated Sep 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access Hospital Clinic/CenterTaxonomy code 261QC0050X
Legal business name
ST. MICHAEL'S HOSPITAL, INC.
Doing business as
Bon Homme Family Practice
Practice address
410 W 16TH Ave
Tyndall, SD 57066-2318
Phone
(605) 589-2100
Fax
(605) 589-2115
NPI assigned
Jun 15, 2006
Last updated
Sep 21, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2020

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

Authorized official

Name
Ashli Danilko
Title
Ceo
Phone
(605) 589-2152

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital Clinic/Center 261QC0050X NU Primary

Addresses

Primary practice location

410 W 16TH Ave
Tyndall, SD 57066-2318

Mailing address

410 W 16TH Ave
Tyndall, SD 57066-2318
Phone (605) 589-2152

Other identifiers 1

IdentifierTypeStateIssuer
4996776OtherSDNRHC BCBS

Other names 1

  • Bon Homme Family Practice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081010000300 SD Part B Supplier - Clinic/Group Practice 2668380262 Receives reassigned benefits from 8 practitioners
Practice locations: Tyndall, SD

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory

Ownership & related parties

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
St Michael's Hospital, Inc.Tyndall, SD, CCN 431327 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
St Michael's Hospital, Inc.Tyndall, SD, CCN 43Z327 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Bon Homme Family PracticeAvon, SD, CCN 433418 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 19, 2002
Bon Homme Family PracticeTyndall, SD, CCN 433416 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 19, 2002

Owned or controlled facilities with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600646400000",
    "number": "1467496158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 W 16TH AVE",
            "city": "TYNDALL",
            "state": "SD",
            "postal_code": "570662318",
            "telephone_number": "605-589-2152",
            "fax_number": "605-589-2115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 W 16TH AVE",
            "city": "TYNDALL",
            "state": "SD",
            "postal_code": "570662318",
            "telephone_number": "605-589-2100",
            "fax_number": "605-589-2115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MICHAEL'S HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-15",
        "last_updated": "2020-09-21",
        "certification_date": "2020-09-21",
        "status": "A",
        "authorized_official_last_name": "DANILKO",
        "authorized_official_first_name": "ASHLI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "605-589-2152"
    },
    "taxonomies": [
        {
            "code": "261QC0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Critical Access Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NRHC BCBS",
            "identifier": "4996776",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bon Homme Family Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bon Homme Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tyndall, SD

Sources for this page

Verify at the official NPI Registry.