NPIMap

Organization Active NPI

Avera St Marys

Doing business as Avera St. Mary's Hospital

  • General Acute Care Hospital
  • Pierre, SD
National Provider Identifier
1669457180
Registry record updated Jul 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
10556 Issued in SD
Legal business name
AVERA ST MARYS
Doing business as
Avera St. Mary's Hospital
Practice address
801 E Sioux Ave
Pierre, SD 57501-3323
Phone
(605) 224-3100
Fax
(605) 224-8339
NPI assigned
Dec 7, 2005
Last updated
Jul 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2022

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

Authorized official

Name
Mikel Holland
Title
Ceo/President
Phone
(605) 224-3144

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 10556 SD Primary

Addresses

Primary practice location

801 E Sioux Ave
Pierre, SD 57501-3323

Mailing address

PO Box 5045
Ste PFS Prov Enrollment
Sioux Falls, SD 57117-5045
Phone (605) 322-6428

Other identifiers 3

IdentifierTypeStateIssuer
0100150MedicaidSD
80015OtherBCBS
5500150MedicaidSD

Other names 1

  • Avera St. Mary's Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20040225000579 SD Part B Supplier - Clinic/Group Practice 0143134965 Receives reassigned benefits from 228 practitioners
3 other NPIs on this enrollment
Practice locations: Pierre, SD
O20040827000352 SD Part A Provider - Skilled Nursing Facility 0143134965 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pierre, SD
O20100726000341 SD Part A Provider - Hospital 0143134965 1 other NPI on this enrollment
Practice locations: Pierre, SD
O20100909001268 SD Part A Provider - Hospital 0143134965 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pierre, SD

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1669457180. Details of each certification follow.

Skilled nursing facility certification: CCN 435034

Legal name
AVERA ST MARYS
Doing business as
AVERA MARYHOUSE LONG TERM CARE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Aug 26, 1985
Last certification
Mar 21, 2024
Beds
80
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Avera Health
Organization structure
OtherNon-profit
Incorporated
Feb 10, 1951 in SD
Enrollment address
801 E Sioux Ave
Maryhouse -Avera Maryhouse Long Term Care
Pierre, SD 57501-3323
Nursing home name
AVERA MARYHOUSE LONG TERM CARE
Affiliated entity
AVERA HEALTH

Hospital certification: CCN 430015

Legal name
AVERA ST MARYS
Doing business as
AVERA ST MARYS HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jun 5, 2014
Beds
60
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Feb 10, 1951 in SD
Enrollment address
801E Sioux Ave
Pierre, SD 57501-3323
Other Hospital Practice Location
Hospital subgroups
Acute care

Hospital certification: CCN 43U015

Legal name
AVERA ST MARYS
Doing business as
AVERA ST MARYS HOSPITAL - SWINGBED
Organization structure
CorporationNon-profit
Incorporated
Feb 10, 1951 in SD
Enrollment address
801E Sioux Ave
Avera St Marys Hospital Swingbed
Pierre, SD 57501-3323
Hospital Swing-Bed Unit
Hospital subgroups
Swing-bed approved

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

Other NPIs with the same Medicare PAC ID 5

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

  • Avera St Marys

    dba Avera Maryhouse Long Term Care

    • Skilled Nursing Facility
    • Pierre, SD
    • NPI 1063654648

    0143134965

    Same PAC ID
  • Avera St Marys

    dba Avera St Marys Hospital - ESRD

    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Pierre, SD
    • NPI 1144238619

    0143134965

    Same PAC ID
  • Avera St Marys

    dba Avera Pierre Clinic

    • Multi-Specialty Clinic/Center
    • Pierre, SD
    • NPI 1720326713

    0143134965

    Same PAC ID
  • Avera St Marys

    dba Avera St. Mary's Hospital Swingbed

    • Medicare Defined Swing Bed Hospital Unit
    • Pierre, SD
    • NPI 1992713457

    0143134965

    Same PAC ID
  • Avera St. Mary's

    dba Avera St. Mary's Campus Pharmacy

    • Community/Retail Pharmacy
    • Pierre, SD
    • NPI 1932651122

    0143134965

    Same PAC ID

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Avera St Mary's HospitalCCN 430015 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Care Compare: Nursing home

Medicare Care Compare
Listed as
Avera Maryhouse Long Term CareCCN 435034 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
5 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Aug 26, 1985
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8058.3 residents per day on average
Chain
Avera Health13 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Member organizations 4

Organizations listed as members of this organization in the National Provider Directory.

Interoperability endpoints

  • Direct secure messaging: janell.gerberding@avera.sdhealthlink.net

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
Robert Wylie Individual Corporate DirectorBoard Member Jul 1, 2021
Managing Control - Governing BodyBoard Member Jul 1, 2021
Jeffrey Paul Hallem Individual Corporate DirectorBoard Member Jul 1, 2025
Managing Control - Governing BodyBoard Member Aug 1, 2024
Amy Kathryn Lueking Individual Corporate DirectorBoard Member Jul 1, 2021
Managing Control - Governing BodyBoard Member Jul 1, 2021
Debra Ann Kolecka Individual Corporate DirectorBoard Member Jul 1, 2025
Managing Control - Governing BodyBoard Member Jul 1, 2024
Rena J Robbennolt Individual Corporate DirectorBoard Member Jul 1, 2025
Managing Control - Governing BodyBoard Member Aug 1, 2024
Meredith Lee Individual Corporate DirectorBoard Member Jul 1, 2022
Managing Control - Governing BodyBoard Member Jul 1, 2022
Julie Lautt Individual Corporate OfficerCfo Mar 1, 2020
Jami Kay Cronin Individual Corporate DirectorBoard Member Jul 1, 2025
Corporate DirectorBoard Member Jul 1, 2021
Shantel Shamiele Krebs Individual Corporate OfficerPresident/Ceo Mar 13, 2023
Operational/Managerial Control Mar 13, 2023
Mark L Hagy Individual Corporate DirectorBoard Member Jul 1, 2022
Managing Control - Governing BodyBoard Member Jul 1, 2022
Avera Health Organization, Sioux Falls, SD Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2013 100%
Operational/Managerial Control Jan 1, 2013
Kristin Brost Individual Corporate DirectorBoard Member Jul 1, 2021
Kimberly Olson Individual Corporate DirectorBoard Member Jul 1, 2022
Managing Control - Governing BodyBoard Member Jul 1, 2022
Michael Weisgram Individual Corporate DirectorBoard Member Jul 1, 2017
Penny Bingham Individual Corporate DirectorBoard Member Jul 1, 2018
Lynn Marie Welbig Individual Corporate DirectorBoard Member Jul 1, 2017
Managing Control - Governing BodyBoard Member Jul 1, 2017
Bobby Lynn Sutton Individual Corporate OfficerPresident/Ceo Avera Health Jun 18, 2018
Michael Larson Individual Corporate DirectorBoard Member Jul 1, 2020
Darrell W Plumage Individual Corporate DirectorMedical Director Aug 7, 2021
Adp of the SNF Apr 17, 2025
Talli Raske Individual Corporate DirectorAdministrator Aug 5, 2015
Adp of the SNF Apr 17, 2025

Owners & managing parties with NPI records 5

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Avera Missouri River Health CenterGettysburg, SD, CCN 431302 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2013
Avera Missouri River Health CenterGettysburg, SD, CCN 43Z302 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2013

Owned or controlled facilities with NPI records 2

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

  • Avera Gettysburg

    dba Avera Missouri River Health Center

    • Critical Access Hospital
    • Gettysburg, SD
    • NPI 1003887266

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Avera Gettysburg

    dba Avera Missouri River Health Center (Swingbed)

    • Medicare Defined Swing Bed Hospital Unit
    • Gettysburg, SD
    • NPI 1881754497

    5% Or Greater Direct Ownership Interest

    CMS ownership

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 236

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 236

Affiliated clinicians 215

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

View all 215

NPI Registry JSON

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

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657843200000",
    "number": "1669457180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5045",
            "address_2": "STE PFS PROV ENROLLMENT",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175045",
            "telephone_number": "605-322-6428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 E SIOUX AVE",
            "city": "PIERRE",
            "state": "SD",
            "postal_code": "575013323",
            "telephone_number": "605-224-3100",
            "fax_number": "605-224-8339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA ST MARYS",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-07",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-15",
        "status": "A",
        "authorized_official_last_name": "HOLLAND",
        "authorized_official_first_name": "MIKEL",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "605-224-3144"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "SD",
            "license": "10556",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0100150",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "80015",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5500150",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera St. Mary's Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avera St. Mary's Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pierre, SD

Sources for this page

Verify at the official NPI Registry.