NPIMap

Organization Active NPI

Mobridge Regional Hospital

  • Critical Access Hospital
  • Mobridge, SD
National Provider Identifier
1871554311
Registry record updated Oct 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
48404 Issued in SD
Legal business name
MOBRIDGE REGIONAL HOSPITAL
Practice address
1401 10TH Ave West
Mobridge, SD 57601-0850
Phone
(605) 845-3692
Fax
(605) 845-8252
NPI assigned
Mar 31, 2006
Last updated
Oct 6, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2016

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

Authorized official

Name
Renae Tisdall
Title
Cfo
Phone
(605) 845-8164

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 48404 SD
Critical Access Hospital 282NC0060X 48404 SD Primary

Addresses

Primary practice location

1401 10TH Ave West
Mobridge, SD 57601-0850

Mailing address

PO Box 580
Mobridge, SD 57601-0580
Phone (605) 845-3692

Other identifiers 2

IdentifierTypeStateIssuer
81325OtherSDBCBS OF SOUTH DAKOTA
5500400MedicaidSD

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031201000671 SD Part A Provider - Critical Access Hospital 6507776135 Receives reassigned benefits from 25 practitioners
1 other NPI on this enrollment
Practice locations: Mobridge, SD
O20040130000772 SD Part B Supplier - Clinic/Group Practice 6507776135 Receives reassigned benefits from 26 practitioners
2 other NPIs on this enrollment
Practice locations: Mobridge, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871554311. Details of each certification follow.

Hospital certification: CCN 431325

Legal name
MOBRIDGE REGIONAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jan 1, 2002
Last certification
Sep 12, 2024
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
May 20, 1953 in SD
Enrollment address
1401 10TH Ave West
Mobridge, SD 57601-1106
Other Hospital Practice Location

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).

Other NPIs on the same Medicare enrollment 3

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Mobridge Regional Hospital - CahCCN 431325 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Renae Karst Individual Corporate OfficerCfo Aug 16, 2016
Corporate Director Aug 16, 2016
W-2 Managing EmployeeCfo Aug 23, 2013
Travis B Henderson Individual Corporate Director Jan 1, 2007
Kristi Kraft Individual W-2 Managing Employee Aug 16, 2016
Christopher Bohlander Individual Corporate Director May 23, 2018
Joshua Wudel Individual Corporate Director Jan 27, 2021
Laurie Bauer Individual Corporate Director Jan 27, 2021
Richard Gross Individual Corporate Director Jan 22, 2020
Adam Hayes Individual Corporate Director Jan 22, 2020
Heidi a Roshau Individual Corporate Director Jan 1, 2000
Patricia Schmeichel Individual Corporate Director Jan 1, 2018
William Bachmeier Individual Corporate Director Jan 1, 2011
Lori Heil Individual Corporate Director Sep 1, 2014
Duane J Kraft Individual Corporate Director Jan 1, 2006
Robert C Marciano Individual Corporate Director Jan 1, 2006
John Ayoub Individual Corporate OfficerCeo Jan 9, 2017
Corporate DirectorCeo Jan 9, 2017
W-2 Managing EmployeeCeo Jan 9, 2017

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 29

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 29

Affiliated clinicians 62

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

View all 62

NPI Registry JSON

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

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475712000000",
    "number": "1871554311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 580",
            "city": "MOBRIDGE",
            "state": "SD",
            "postal_code": "576010580",
            "telephone_number": "605-845-3692",
            "fax_number": "605-845-8252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 10TH AVE WEST",
            "city": "MOBRIDGE",
            "state": "SD",
            "postal_code": "576010850",
            "telephone_number": "605-845-3692",
            "fax_number": "605-845-8252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBRIDGE REGIONAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-31",
        "last_updated": "2016-10-06",
        "status": "A",
        "authorized_official_last_name": "TISDALL",
        "authorized_official_first_name": "RENAE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "605-845-8164"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "SD",
            "license": "48404",
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "SD",
            "license": "48404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF SOUTH DAKOTA",
            "identifier": "81325",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5500400",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mobridge, SD

Sources for this page

Verify at the official NPI Registry.