NPIMap

Organization Active NPI

Monument Health Home Plus, LLC

Doing business as Monument Health Home Plus Hospice

  • Inpatient Hospice
  • Rapid City, SD
National Provider Identifier
1639629256
Registry record updated Aug 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Inpatient HospiceTaxonomy code 315D00000X
Legal business name
MONUMENT HEALTH HOME PLUS, LLC
Doing business as
Monument Health Home Plus Hospice
Practice address
224 Elk St
Rapid City, SD 57701-7359
Phone
(605) 755-7710
Fax
(605) 755-7780
NPI assigned
Oct 6, 2016
Last updated
Aug 3, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
MONUMENT HEALTH HOME PLUS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 3, 2022

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

Authorized official

Name
Michael Tilles
Title
President Monument Health Home Plus
Phone
(605) 519-1179

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Inpatient Hospice 315D00000X Primary

Addresses

Primary practice location

224 Elk St
Rapid City, SD 57701-7359

Mailing address

PO Box 860013
Minneapolis, MN 55486-0013
Phone (605) 755-7649

Other names 1

  • Monument Health Home Plus Hospice Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solution

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161201001308 SD Part A Provider - Hospice 8729367776 Practice locations: Rapid City, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639629256. Details of each certification follow.

Hospice certification: CCN 431501

Legal name
MONUMENT HEALTH HOME PLUS LLC
Doing business as
MONUMENT HEALTH HOME PLUS HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
May 21, 1986
Last certification
Oct 30, 2019
Ownership / control type
Proprietary - Corporation
Organization structure
LLCNon-profit
Incorporated
Jul 1, 2016 in SD
Enrollment address
224 Elk St
Rapid City, SD 57701-7359

Other NPIs with the same Medicare PAC ID 10

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Monument Health Home Plus HospiceCCN 431501 · All quality measures
Ownership
For-Profit
Certified
May 21, 1986
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Regional Health Home Plus LLC11 organizations share this tax ID, including this one
Part of
Regional Health Home Plus LLC

Other organizations with this tax ID 10

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Ruta P Davidson Individual Operational/Managerial ControlPresident & Ceo Aug 18, 2018 100%
Michelle Sieveke Individual W-2 Managing EmployeeDirector Jul 11, 2017 50%
Operational/Managerial ControlDirector Jul 1, 2017 50%
Andrea Kristine Baier Individual Contracted Managing EmployeeMD; Jan 1, 2016
Monument Health Rapid City Hospital Inc Organization, Rapid City, SD Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2016 100%
Monument Health Inc Organization, Rapid City, SD Non-profit 5% Or Greater Indirect Ownership Interest Jul 1, 2016 100%
Michael F Tilles Individual Corporate OfficerPresident Sep 19, 2016
W-2 Managing EmployeePresident Sep 19, 2016

Owners & managing parties with NPI records 5

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

Facilities with the same owner 18

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

View all 18

Change-of-ownership history 1

DateEventCounterparty
Nov 1, 2016 Change of OwnershipThis provider was the buyer Rapid City Regional Hospital HospiceCCN 431501, SD, NPI 1962479600

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Affiliated clinicians 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1475712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659484800000",
    "number": "1639629256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860013",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554860013",
            "telephone_number": "605-755-7649",
            "fax_number": "605-755-7884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 ELK ST",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577017359",
            "telephone_number": "605-755-7710",
            "fax_number": "605-755-7780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONUMENT HEALTH HOME PLUS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MONUMENT HEALTH HOME PLUS, LLC",
        "enumeration_date": "2016-10-06",
        "last_updated": "2022-08-03",
        "certification_date": "2022-08-03",
        "status": "A",
        "authorized_official_last_name": "TILLES",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT MONUMENT HEALTH HOME PLUS",
        "authorized_official_telephone_number": "605-519-1179"
    },
    "taxonomies": [
        {
            "code": "315D00000X",
            "taxonomy_group": "",
            "desc": "Hospice, Inpatient",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solution",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Monument Health Home Plus Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rapid City, SD

Sources for this page

Verify at the official NPI Registry.