NPIMap

Organization Active NPI

Avera McKennan

Doing business as Avera Prince of Peace

  • Skilled Nursing Facility
  • Sioux Falls, SD
National Provider Identifier
1508854340
Registry record updated Oct 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
10722 Issued in SD
Legal business name
AVERA MCKENNAN
Doing business as
Avera Prince of Peace
Practice address
4513 S Prince of Peace PL
Sioux Falls, SD 57103-5830
Phone
(605) 322-5600
NPI assigned
Oct 6, 2005
Last updated
Oct 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2023

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

Authorized official

Name
Ronald Joseph Place, MD
Title
President/Ceo
Phone
(605) 322-7903

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 10722 SD
Skilled Nursing Facility 314000000X 10722 SD Primary

Addresses

Primary practice location

4513 S Prince of Peace PL
Sioux Falls, SD 57103-5830

Mailing address

4500 S Prince of Peace PL
Sioux Falls, SD 57103-5830
Phone (605) 322-5600

Other practice location 1

4500 S Prince Of Peace Pl
Sioux Falls, SD 57103-5830
Phone (605) 322-5600

Other identifiers 3

IdentifierTypeStateIssuer
85066OtherSDBLUE CROSS OF SD
0151172MedicaidSD
9572080MedicaidSD

Other names 1

  • Avera Prince of Peace Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090423000690 SD Part A Provider - Skilled Nursing Facility 0345157103 Practice locations: Sioux Falls, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508854340. Details of each certification follow.

Skilled nursing facility certification: CCN 435066

Legal name
AVERA MCKENNAN
Doing business as
AVERA PRINCE OF PEACE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 1, 1992
Last certification
Mar 14, 2024
Beds
126
Ownership / control type
Church Related
Multi-facility organization
Avera Health
Organization structure
OtherNon-profit
Incorporated
May 23, 1925 in SD
Enrollment address
4513 S Prince of Peace PL
Sioux Falls, SD 57103-5830
Nursing home name
AVERA PRINCE OF PEACE
Affiliated entity
AVERA HEALTH

Care Compare: Nursing home

Medicare Care Compare
Listed as
Avera Prince of PeaceCCN 435066 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
5 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Church related
Certified
Oct 1, 1992
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
126120.5 residents per day on average
Chain
Avera Health13 facilities in the chain
Penalties (3 years)
1Fines totaling $8,278

Processed by Care Compare on Aug 1, 2026.

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
43D0041496Avera Prince of Peace Retirement Community4513 Prince of Peace Place, Sioux Falls, SD 57103Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Presentation Health Sys105 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

4500 S Prince of Peace Pl
Sioux Falls, SD 57103
Phone (605) 322-5600

Ownership & related parties

All disclosed owners & managing parties 26

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

NameRoleSinceShare
Alisa L Reindl Individual Managing Control - Governing BodyBoard Member Jul 1, 2021
James Francis Dover Individual Operational/Managerial Control Oct 23, 2023
Van Fishback Individual Managing Control - Governing BodyBoard Member Jul 1, 2018
Candyce C Chrystal Individual Managing Control - Governing BodyBoard Member Jul 1, 2023
Joseph Glendon Rees Individual Operational/Managerial Control Nov 1, 2018
Adp of the SNF Feb 9, 2026
Harriet Yocum Individual Managing Control - Governing BodyBoard Member Jul 1, 2021
Jennifer Bunkers Individual Managing Control - Governing BodyBoard Member Jul 1, 2021
Randy Knecht Individual Managing Control - Governing BodyBoard Member Jul 1, 2018
Jawad Nazir Individual Managing Control - Governing BodyBoard Member Jul 1, 2020
Lucille F Welbig Individual Managing Control - Governing BodyBoard Member Jul 1, 2014
Joseph Patrick Costello Individual Managing Control - Governing BodyBoard Member Jul 1, 2017
Sanaa Abourezk Individual Managing Control - Governing BodyBoard Member Jul 1, 2024
Laurie Knutson Individual Managing Control - Governing BodyBoard Member Jul 1, 2017
Ryan Boschee Individual Managing Control - Governing BodyBoard Member Jul 1, 2024
Brenda K Kallemeyn Individual Managing Control - Governing BodyBoard Member Jul 1, 2023
Jennifer Kirby Individual Managing Control - Governing BodyBoard Member Jul 1, 2020
Ronald J. Place Individual Corporate OfficerPresident/Ceo Jun 5, 2023
Managing Control - Governing BodyPresident/Ceo Jun 5, 2023
Patrick Berry Individual Operational/Managerial Control Mar 25, 2025
Adp of the SNF Jun 18, 2025
Julie Lautt Individual Corporate OfficerCfo Mar 1, 2020
Adp of the SNF Mar 1, 2020
Mary C Curran Individual Managing Control - Governing BodyBoard Member Jul 1, 2015
Avera Health Organization, Sioux Falls, SD Non-profit, Chain home office 5% Or Greater Direct Ownership Interest Jun 15, 1992 100%
Operational/Managerial Control Jan 1, 2000
Trustee of the SNF Jan 1, 2000
Adp of the SNF Jun 18, 2025
Roxanne P Seifert Individual Managing Control - Governing BodyBoard Member Jul 1, 2022
Jeffrey Gordon Individual Managing Control - Governing BodyBoard Member Jul 1, 2023
Cristina a Hill Jensen Individual Managing Control - Governing BodyBoard Member Jul 1, 2018
Organization, Fargo, ND Consulting firm, For-profit Adp of the SNF Jan 1, 2000
Benjamin M Solomon Individual Managing Control - Governing BodyBoard Member Jul 1, 2022

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 9

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

FacilityTypeRoleSince
Lakes Regional HealthcareSpirit Lake, IA, CCN 160124 Hospital Operational/Managerial Control Oct 24, 2022
Avera Heart Hospital of South DakotaSioux Falls, SD, CCN 430095 Hospital 5% Or Greater Direct Ownership Interest (33.33%) Oct 1, 2010
Avera Holy Family HospitalEstherville, IA, CCN 161351 Hospital Operational/Managerial Control Oct 6, 1994
Avera Holy Family HospitalEstherville, IA, CCN 16Z351 Hospital Operational/Managerial Control Jan 1, 2007
Lakes Regional HealthcareSpirit Lake, IA, CCN 16U124 Hospital Operational/Managerial Control Oct 24, 2022
United Living CommunityBrookings, SD, CCN 435079 Skilled nursing facility Operational/Managerial Control Nov 15, 2005
Freeman Regional Health ServicesMenno, SD, CCN 433444 Rural health clinic 5% Or Greater Direct Ownership Interest (50%) May 1, 2011
Freeman Regional Health ServicesBridgewater, SD, CCN 433443 Rural health clinic 5% Or Greater Direct Ownership Interest (50%) May 1, 2011
Freeman Regional Health ServicesMarion, SD, CCN 433445 Rural health clinic 5% Or Greater Direct Ownership Interest (50%) May 1, 2011

Facilities with the same owner 90

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

View all 90

Practitioners & affiliated clinicians

Practitioners 4

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.

Affiliated clinicians 3

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

NPI Registry JSON

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

{
    "created_epoch": "1128556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1508854340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 S PRINCE OF PEACE PL",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571035830",
            "telephone_number": "605-322-5600",
            "fax_number": "605-322-5622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4513 S PRINCE OF PEACE PL",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571035830",
            "telephone_number": "605-322-5600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4500 S Prince Of Peace Pl",
            "address_purpose": "LOCATION",
            "city": "Sioux Falls",
            "state": "SD",
            "postal_code": "571035830",
            "country_code": "US",
            "telephone_number": "605-322-5600",
            "fax_number": "605-322-5622",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AVERA MCKENNAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-06",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A",
        "authorized_official_last_name": "PLACE",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "605-322-7903",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "SD",
            "license": "10722",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "SD",
            "license": "10722",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF SD",
            "identifier": "85066",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0151172",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9572080",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Prince of Peace",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avera Prince of Peace",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.