NPIMap

Organization Active NPI

Black Hills Surgical Hospital, LLC

  • Special Hospital
  • Rapid City, SD
National Provider Identifier
1679535132
Registry record updated May 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Special HospitalTaxonomy code 284300000X
License
10582 Issued in SD
Legal business name
BLACK HILLS SURGICAL HOSPITAL, LLC
Doing business as
Black Hills Surgical Hospital, LLC
Practice address
216 Anamaria Dr
Rapid City, SD 57701-7366
Phone
(605) 721-4700
NPI assigned
Apr 3, 2006
Last updated
May 1, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2026

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

Authorized official

Name
Tina Weston
Title
Cfo
Phone
(605) 721-4922

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Special Hospital 284300000X 10582 SD Primary

Addresses

Primary practice location

216 Anamaria Dr
Rapid City, SD 57701-7366

Mailing address

1868 Lombardy Dr
Rapid City, SD 57703-4130
Phone (605) 721-4934

Other identifiers 2

IdentifierTypeStateIssuer
0108020MedicaidSD
5508020MedicaidSD

Other names 2

  • Black Hills Surgical Hospital, LLC Doing business as
  • Black Hills Surgery Center, LLP Former legal business name

Electronic endpoints 1

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040428000630 SD Part A Provider - Hospital 5496742835 Practice locations: Rapid City, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679535132. Details of each certification follow.

Hospital certification: CCN 430091

Legal name
BLACK HILLS SURGICAL HOSPITAL LLC
Doing business as
BLACK HILLS SURGICAL HOSPITAL LLC
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Feb 20, 1997
Last certification
Sep 27, 2018
Beds
26
Ownership / control type
Private (for profit)
Organization structure
LLCNon-profit
Enrollment address
216 Anamaria Dr
Rapid City, SD 57701-7366
Other Hospital Practice Location
Hospital subgroups
Acute care, Specialty hospital

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Black Hills Surgical Hospital LLCCCN 430091 · All quality measures
Type
Acute Care Hospitals
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
Black Hills Surgical Hospital LLC11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
Mark Allen Lundeen Individual Corporate Officer Nov 15, 2024
Corporate DirectorTrustee Nov 15, 2024
Marnie Lynn Ventling-Herrmann Individual Corporate OfficerVice Chairperson Nov 15, 2024
Corporate DirectorTrustee Nov 15, 2024
Tony Lee Morrison Individual Corporate Officer Nov 15, 2024
W-2 Managing EmployeeVP Revenue Cycle Nov 15, 2024
Brent Gerard Teiken Individual Corporate DirectorTrustee Nov 15, 2024
Dana James Dykhouse Individual Corporate DirectorTrustee Nov 15, 2024
Andrew Stewart North Individual Corporate Officer Nov 15, 2024
Corporate DirectorTrustee Nov 15, 2024
Sanford Health of South Dakota Organization, Sioux Falls, SD Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Nov 15, 2024 100%
Stephanie Marie Herseth Sandlin Individual Corporate DirectorTrustee Nov 15, 2024
William Joseph Gassen Individual Corporate OfficerCeo Nov 15, 2024
Corporate DirectorDirector Nov 15, 2024
George Joseph Brown Individual Corporate Director Jan 1, 2025
Wesley Owen Engbrecht Individual Corporate DirectorTrustee Nov 15, 2024
Tina Weston Individual W-2 Managing Employee Nov 15, 2024
Maureen Patricia McCausland Individual Corporate DirectorTrustee Jan 1, 2025
Sanford Organization, Fargo, ND Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Nov 15, 2024 100%
Thomas Richard Wenzel Individual Corporate DirectorTrustee Jan 1, 2025
David Jonathan Shulkin Individual Corporate DirectorTrustee Nov 15, 2024
Kyle Wiese Individual W-2 Managing EmployeePresident Nov 15, 2024
Neil Leslie Gulsvig Individual Corporate DirectorTrustee Nov 15, 2024
Kevin Victor Schieffer Individual Corporate Director Jan 1, 2025
Lauris Nelson Molbert Individual Corporate OfficerChairperson Nov 15, 2024
Corporate DirectorTrustee Nov 15, 2024
Nicholas Wayne Olson Individual Corporate Officer Nov 15, 2024
W-2 Managing EmployeeChief Financial Officer Nov 15, 2024

Practitioners & affiliated clinicians

Practitioners 2

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 165

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

View all 165

NPI Registry JSON

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

{
    "created_epoch": "1144022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777593600000",
    "number": "1679535132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1868 LOMBARDY DR",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577034130",
            "telephone_number": "605-721-4934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 ANAMARIA DR",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577017366",
            "telephone_number": "605-721-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK HILLS SURGICAL HOSPITAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-03",
        "last_updated": "2026-05-01",
        "certification_date": "2026-05-01",
        "status": "A",
        "authorized_official_last_name": "WESTON",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "605-721-4922"
    },
    "taxonomies": [
        {
            "code": "284300000X",
            "taxonomy_group": "",
            "desc": "Special Hospital",
            "state": "SD",
            "license": "10582",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0108020",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5508020",
            "state": "SD"
        }
    ],
    "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 Solutions",
            "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": "Black Hills Surgical Hospital, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Black Hills Surgery Center, LLP",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Rapid City, SD

Sources for this page

Verify at the official NPI Registry.