NPIMap

Organization Active NPI

Avera Holy Family

Doing business as Avera Holy Family Hospital

  • Critical Access Hospital
  • Estherville, IA
National Provider Identifier
1508810177
Registry record updated Jul 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
320014H Issued in IA
Legal business name
AVERA HOLY FAMILY
Doing business as
Avera Holy Family Hospital
Practice address
826 N 8TH St
Estherville, IA 51334-1528
Phone
(712) 362-2631
Fax
(712) 362-2636
NPI assigned
May 19, 2006
Last updated
Jul 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2021

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

Authorized official

Name
Mr. Deb Herzberg
Title
Ceo
Phone
(712) 362-6160

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 320014H IA Primary

Addresses

Primary practice location

826 N 8TH St
Estherville, IA 51334-1528

Mailing address

826 N 8TH St
Estherville, IA 51334-1528
Phone (712) 362-2631

Other identifiers 4

IdentifierTypeStateIssuer
0600023MedicaidIA
0016HHOOtherMNBLUE CROSS CAH
60002OtherIAWELLMARK CAH
677247100MedicaidMN

Other names 1

  • Avera Holy Family Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040211000244 IA Part B Supplier - Mass Immunization (Roster Biller Only) 7113837428 Practice locations: Estherville, IA
O20061104000150 IA Part A Provider - Critical Access Hospital 7113837428 Receives reassigned benefits from 65 practitioners
Practice locations: Estherville, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508810177. Details of each certification follow.

Hospital certification: CCN 161351

Legal name
AVERA HOLY FAMILY
Doing business as
AVERA HOLY FAMILY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Aug 1, 2003
Last certification
Jul 22, 2021
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
826 N 8TH St
Estherville, IA 51334-1528

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

Other NPIs with the same Medicare PAC ID 3

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Avera Holy Family HospitalCCN 161351 · All quality measures
Overall star rating
2 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Holy Family Hospital5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
James Francis Dover Individual Corporate OfficerFache, President/Ceo Avera Health Oct 23, 2023
Avera McKennan Organization, Sioux Falls, SD Non-profit Operational/Managerial Control Oct 6, 1994
Candyce C Chrystal Individual Corporate DirectorBoard Member Jul 1, 2022
Mike Cornwall Individual Corporate DirectorBoard Member Jul 1, 2018
Amanda Marie Schutz Individual Corporate OfficerBilling Services Officer Oct 1, 2019
Edward James Rosendahl Individual Corporate DirectorBoard Member Jul 1, 2023
Yas Mata Individual Corporate DirectorBoard Member Jul 1, 2022
Avera Holy Family Organization, Estherville, IA Non-profit Operational/Managerial Control Nov 20, 2007
Robert Jensen Individual Corporate DirectorBoard Member Jul 1, 2022
Penny Clayton Individual Corporate DirectorBoard Member Jul 1, 2023
Michelle Majerus Individual Corporate OfficerCeo Sep 30, 2024
W-2 Managing EmployeeCeo Sep 30, 2024
Operational/Managerial ControlCeo Sep 30, 2024
Avera Health Organization, Sioux Falls, SD Corporation, Non-profit 5% Or Greater Direct Ownership Interest Oct 6, 1994 100%
Operational/Managerial Control Dec 20, 2007
Janet K Schumacher Individual Corporate DirectorBoard Member Jul 1, 2020

Owners & managing parties with NPI records 3

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

Facilities with the same owner 97

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 97

Practitioners & affiliated clinicians

Practitioners 86

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.

View all 86

Affiliated clinicians 100

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

View all 100

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625184000000",
    "number": "1508810177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "826 N 8TH ST",
            "city": "ESTHERVILLE",
            "state": "IA",
            "postal_code": "513341528",
            "telephone_number": "712-362-2631",
            "fax_number": "712-362-2636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "826 N 8TH ST",
            "city": "ESTHERVILLE",
            "state": "IA",
            "postal_code": "513341528",
            "telephone_number": "712-362-2631",
            "fax_number": "712-362-2636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA HOLY FAMILY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2021-07-02",
        "certification_date": "2021-07-02",
        "status": "A",
        "authorized_official_last_name": "HERZBERG",
        "authorized_official_first_name": "DEB",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "712-362-6160",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IA",
            "license": "320014H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0600023",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS CAH",
            "identifier": "0016HHO",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK CAH",
            "identifier": "60002",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "677247100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Holy Family Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avera Holy Family Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Estherville, IA

Sources for this page

Verify at the official NPI Registry.