Avera McKennan
Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Dell Rapids, SD
NPI 1710089172 · NPPES record last updated Oct 4, 2023
Key facts
- NPI
- 1710089172
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medicare Defined Swing Bed Hospital Unit 275N00000X
- License
- 50754 (SD)
- Legal business name
- AVERA MCKENNAN
- Practice address
- 909 North Iowa Ave
Dell Rapids, SD 57022-1231 - Phone
- (605) 428-5431
- Fax
- (605) 428-3906
- NPI assigned
- Sep 5, 2006
- Organization subpart
- No
Authorized official
- Name
- Ronald Joseph Place, MD
- Title
- President/Ceo
- Phone
- (605) 322-7903
Owners & managing parties with NPI records 4
-
Jawad Nazir, MD
-
Alisa L Reindl, MD
-
Tamera Lee Sturm, D.O.
Corporate family (same tax ID) 24
Related certifications (CCN) 1
Facilities with the same owner 90
Affiliated clinicians 3
-
Matt E. Herber, MD
-
Rachel Kramer, CNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SD
Hospital certification: CCN 43Z331
- Legal name
- AVERA MCKENNAN
- Doing business as
- AVERA DELLS AREA HOSPITAL SWINGBED
- Organization structure
- Other · Non-profit
- Incorporated
- May 23, 1925 in SD
- Enrollment address
- 909 N Iowa Ave
Dell Rapids, SD 57022-1231
All disclosed owners & managing parties 19
| Name | Role | Since | Share |
|---|---|---|---|
| Alisa L Reindl |
Corporate Director |
Jul 1, 2021 | |
| Tamera L Sturm |
Corporate Director |
Jul 1, 2025 | |
| Van Fishback |
Corporate Director |
Jul 1, 2018 | |
| Candyce C Chrystal |
Corporate Director |
Jul 1, 2023 | |
| Harriet Yocum |
Corporate Director |
Jul 1, 2021 | |
| Jennifer Bunkers |
Corporate Director |
Jul 1, 2021 | |
| Randy Knecht |
Corporate Director |
Jul 1, 2018 | |
| Jawad Nazir |
Corporate Director |
Jul 1, 2020 | |
| Lucille F Welbig |
Corporate Director |
Jul 1, 2014 | |
| Joseph Patrick Costello |
Corporate Director |
Jul 1, 2017 | |
| Sanaa Abourezk |
Corporate Director |
Jul 1, 2024 | |
| Ryan Boschee |
Corporate Director |
Jul 1, 2025 | |
| Jennifer Kirby |
Corporate Director |
Jul 1, 2020 | |
| Ronald J. Place |
Corporate Officer |
Jun 5, 2023 | |
| Operational/Managerial Control | Jun 5, 2023 | ||
| Julie Lautt |
Corporate Officer |
Mar 1, 2020 | |
| Mary C Curran |
Corporate Director |
Jul 1, 2018 | |
| Avera Health |
5% Or Greater Direct Ownership Interest | Jun 15, 1992 | 100% |
| Operational/Managerial Control | Jun 15, 1992 | ||
| Roxanne P Seifert |
Corporate Director |
Jul 1, 2022 | |
| Cristina a Hill Jensen |
Corporate Director |
Jul 1, 2018 |
All facility ownership & control disclosures 9
| Facility | Type | Role | Since |
|---|---|---|---|
| Lakes Regional Healthcare |
Hospital | Operational/Managerial Control | Oct 24, 2022 |
| Avera Heart Hospital of South Dakota |
Hospital | 5% Or Greater Direct Ownership Interest (33.33%) | Oct 1, 2010 |
| Avera Holy Family Hospital |
Hospital | Operational/Managerial Control | Oct 6, 1994 |
| Avera Holy Family Hospital |
Hospital | Operational/Managerial Control | Jan 1, 2007 |
| Lakes Regional Healthcare |
Hospital | Operational/Managerial Control | Oct 24, 2022 |
| United Living Community |
Skilled nursing facility | Operational/Managerial Control | Nov 15, 2005 |
| Freeman Regional Health Services |
Rural health clinic | 5% Or Greater Direct Ownership Interest (50%) | May 1, 2011 |
| Freeman Regional Health Services |
Rural health clinic | 5% Or Greater Direct Ownership Interest (50%) | May 1, 2011 |
| Freeman Regional Health Services |
Rural health clinic | 5% Or Greater Direct Ownership Interest (50%) | May 1, 2011 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070125000521 | SD | Part a Provider - Critical Access Hospital | 0345157103 | Practice locations: Dell Rapids, SD |
National Provider Directory
- Tax ID family
- Avera McKennan Hosp
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | 50754 | SD | Yes |
Addresses
Primary practice location
909 North Iowa Ave
Dell Rapids, SD 57022-1231
Mailing address
PO Box 5045 Attn Prvenrolmt Palm Place BLDG
Sioux Falls, SD 57117-5045
Phone (605) 322-6428
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0159800 | Medicaid | SD | |
| 8B027 | Other | SD | SD BLUE CROSS SWBED PROV# |
Other names
- Avera Dells Area Hospital Swingbed
Other providers in Dell Rapids, SD
- Julia Agnes Abraham
- Courtney Almendinger
- Jill Anderson
- Avera McKennan
- Avera McKennan
- Alec Michael Baker
- Chirosport Dell Rapids PC
- City of Dell Rapids
- Bethany Crisp
- Kelli De Waard
All providers in Dell Rapids, SD · Medicare Defined Swing Bed Hospital Unit in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 4, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.