NPIMap

Organization Active NPI

Avera St Anthonys Hospital

Doing business as Avera Medical Group O'Neill

  • Rural Health Clinic/Center
  • O'Neill, NE
National Provider Identifier
1861787194
Registry record updated Jul 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
AVERA ST ANTHONYS HOSPITAL
Doing business as
Avera Medical Group O'Neill
Practice address
300 N 2ND St
Suite 100
Oneill, NE 68763-1519
Phone
(402) 336-2900
NPI assigned
Jun 15, 2011
Last updated
Jul 6, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
AVERA ST ANTHONYS HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 6, 2021

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

Authorized official

Name
Mr. Todd E. Consbruck
Title
Ceo
Phone
(402) 336-2611

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Physician Assistant 363A00000X
Nurse Practitioner 363L00000X
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X

Addresses

Primary practice location

300 N 2ND St
Suite 100
Oneill, NE 68763-1519

Mailing address

PO Box 270
Oneill, NE 68763-0270
Phone (402) 336-5154

Other identifiers 2

IdentifierTypeStateIssuer
10026170000MedicaidNE
10026174900MedicaidNE

Other names 1

  • Avera Medical Group O'Neill Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040212000065 NE Part B Supplier - Clinic/Group Practice 4486548203 Receives reassigned benefits from 48 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Spencer, NE; Page, NE; O'Neill, NE; Ewing, NE; Creighton, NE; Chambers, NE; Bassett, NE; Atkinson, NE…
O20110721000067 NE Part A Provider - Rural Health Clinic 4486548203 Practice locations: Oneill, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861787194. Details of each certification follow.

Rural health clinic certification: CCN 288507

Legal name
AVERA ST ANTHONYS HOSPITAL
Doing business as
AVERA MEDICAL GROUP O'NEILL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 1, 2010
Last certification
Nov 29, 2023
Ownership / control type
2B
Most recent change of ownership
Jun 25, 2011 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Jul 25, 1963 in NE
Enrollment address
300 N 2ND St
Ste 100
Oneill, NE 68763-1519
Related CCNs
281329

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
Part of
Anthony E Akainda MD

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
James Francis Dover Individual Corporate OfficerFache, President/Ceo Avera Health Oct 23, 2023
Russell J McIntosh Individual Corporate DirectorBoard Member Jul 1, 2020
John Kozyra Individual Corporate OfficerPresident/Ceo Jan 29, 2024
Operational/Managerial ControlPresident/Ceo Jan 29, 2024
Jewel Swanson Individual Corporate DirectorBoard Member Jul 1, 2023
Cindy a Jakubowski Individual W-2 Managing EmployeeClinic Manager Nov 1, 2014
Operational/Managerial ControlClinic Manager Nov 1, 2014
Debra L Kelly Individual Corporate DirectorBoard Member Jul 1, 2020
Amanda Marie Schutz Individual Corporate OfficerOfficer Billing Services Jun 18, 2018
Susan Dennis Individual Corporate DirectorBoard Member Jul 1, 2022
Barton Becker Individual Corporate DirectorBoard Member Jul 1, 2021
Sacred Heart Health Services Organization, Yankton, SD Non-profit Operational/Managerial Control Feb 1, 1998
Ryan a Banks Individual Corporate DirectorMedical Staff President Jan 1, 2016
W-2 Managing EmployeeMedical Director Jan 1, 2016
Operational/Managerial ControlMedical Director Jan 1, 2016
Julie Lautt Individual Corporate OfficerCfo Mar 1, 2020
Bonita Gacnik Individual Corporate DirectorBoard Member Jul 1, 2022
Avera Health Organization, Sioux Falls, SD Non-profit 5% Or Greater Direct Ownership Interest Sep 1, 2000 100%
Operational/Managerial Control Sep 1, 2000
Amy Shane Individual Corporate DirectorBoard Member Jul 1, 2020
Cody Boettcher Individual Corporate DirectorBoard Member Jul 1, 2023
Merri Schneider Individual Corporate DirectorBoard Member Jul 1, 2020
Mark Hunhoff Individual Corporate DirectorBoard Member Jul 1, 2023

Owners & managing parties with NPI records 19

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

View all 19

Facilities with the same owner 96

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

View all 96

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

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1308096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625529600000",
    "number": "1861787194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 270",
            "city": "ONEILL",
            "state": "NE",
            "postal_code": "687630270",
            "telephone_number": "402-336-5154",
            "fax_number": "402-336-5137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 N 2ND ST",
            "address_2": "SUITE 100",
            "city": "ONEILL",
            "state": "NE",
            "postal_code": "687631519",
            "telephone_number": "402-336-2900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA ST ANTHONYS HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AVERA ST ANTHONYS HOSPITAL",
        "enumeration_date": "2011-06-15",
        "last_updated": "2021-07-06",
        "certification_date": "2021-07-06",
        "status": "A",
        "authorized_official_last_name": "CONSBRUCK",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "402-336-2611",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10026170000",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10026174900",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Medical Group O'Neill",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avera Medical Group O'Neill",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in O'Neill, NE

Sources for this page

Verify at the official NPI Registry.