NPIMap

Organization Active NPI

Platte Community Memorial Hospital Inc

Doing business as Geddes Medical Clinic

  • Rural Health Clinic/Center
  • Geddes, SD
National Provider Identifier
1730186073
Registry record updated Mar 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
10557 Issued in SD
Legal business name
PLATTE COMMUNITY MEMORIAL HOSPITAL INC
Doing business as
Geddes Medical Clinic
Practice address
322 S Main St
Geddes, SD 57342-1046
Phone
(605) 337-3197
Fax
(605) 337-3873
NPI assigned
Jul 1, 2005
Last updated
Mar 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2024

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

Authorized official

Name
Mr. Mark A Burket
Title
Ceo
Phone
(605) 337-3364

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 10557 SD Primary

Addresses

Primary practice location

322 S Main St
Geddes, SD 57342-1046

Mailing address

PO Box 169
Geddes, SD 57342-0169
Phone (605) 337-3197

Other identifiers 1

IdentifierTypeStateIssuer
5340400MedicaidSD

Other names 1

  • Geddes Medical Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060206000402 SD Part A Provider - Rural Health Clinic 6507770054 Practice locations: Geddes, SD
O20061018000130 SD Part B Supplier - Clinic/Group Practice 6507770054 Receives reassigned benefits from 13 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Platte, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730186073. Details of each certification follow.

Rural health clinic certification: CCN 433414

Legal name
PLATTE COMMUNITY MEMORIAL HOSPITAL INC
Doing business as
GEDDES MEDICAL CLINIC AVERA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 1, 2002
Last certification
May 11, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Dec 21, 1992 in SD
Enrollment address
322 Main St
Geddes, SD 57342
Related CCNs
431306

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

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

111 E 10th St
Dell Rapids, SD 57022
Phone (605) 428-5446

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Ann Johnson Individual Corporate DirectorBoard Member Nov 1, 2019
Dennis Vanderwerff Individual Corporate DirectorPresident Nov 1, 2015
Valerie Kotilinek Individual W-2 Managing EmployeeLead Medical Biller Nov 10, 2010
Jill Gustad Individual Corporate DirectorBoard Member Nov 1, 2019
Karen Turnis Individual Corporate DirectorBoard Member Nov 1, 2020
Robert Graves Individual Corporate DirectorBoard Member Nov 1, 2018
Brandi Delange Individual Corporate DirectorTreasurer Nov 1, 2018
Mark a Burket Individual Corporate OfficerCeo Aug 1, 1996
Jesse Block Individual Corporate DirectorVice President Nov 1, 2018
Vicki Jensen Individual Corporate OfficerCfo May 24, 2010
Dennis Severson Individual Corporate DirectorBoard Member Nov 1, 2022
Kim Ehlers Individual Corporate DirectorBoard Member Nov 1, 2022

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Platte Medical Clinic AveraPlatte, SD, CCN 433415 Rural health clinic Operational/Managerial Control (100%) Oct 1, 1996
White Lake Medical Clinic AveraWhite Lake, SD, CCN 433439 Rural health clinic Operational/Managerial Control (100%) Jul 1, 2015

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1120176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710115200000",
    "number": "1730186073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 169",
            "city": "GEDDES",
            "state": "SD",
            "postal_code": "573420169",
            "telephone_number": "605-337-3197",
            "fax_number": "605-337-3873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 S MAIN ST",
            "city": "GEDDES",
            "state": "SD",
            "postal_code": "573421046",
            "telephone_number": "605-337-3197",
            "fax_number": "605-337-3873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLATTE COMMUNITY MEMORIAL HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-01",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A",
        "authorized_official_last_name": "BURKET",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "605-337-3364",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "SD",
            "license": "10557",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5340400",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Geddes Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Geddes, SD

Sources for this page

Verify at the official NPI Registry.