NPIMap

Organization Active NPI

Eureka Community & Benevolent Hospital

Doing business as Eureka Community Health Services

  • Rural Health Clinic/Center
  • Eureka, SD
National Provider Identifier
1881047371
Registry record updated May 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
EUREKA COMMUNITY & BENEVOLENT HOSPITAL
Doing business as
Eureka Community Health Services
Eureka Medical Clinic Avera
Practice address
200 J Ave Ste a
Eureka, SD 57437-2225
Phone
(605) 284-2661
Fax
(605) 284-2054
NPI assigned
Jul 20, 2016
Last updated
May 1, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
EUREKA COMMUNITY & BENEVOLENT HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 1, 2020

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

Authorized official

Name
Carmen Weber
Title
Administrator
Phone
(605) 284-2661

Specialties & licenses 1

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

Addresses

Primary practice location

200 J Ave Ste a
Eureka, SD 57437-2225

Mailing address

PO Box 517
Eureka, SD 57437-0517

Other names 2

  • Eureka Community Health Services Doing business as
  • Eureka Medical Clinic Avera Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160825002692 SD Part B Supplier - Clinic/Group Practice 5698711653 Receives reassigned benefits from 9 practitioners
1 other NPI on this enrollment
Practice locations: Eureka, SD
O20161213002500 SD Part A Provider - Rural Health Clinic 5698711653 Practice locations: Eureka, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881047371. Details of each certification follow.

Rural health clinic certification: CCN 433449

Legal name
EUREKA COMMUNITY & BENEVOLENT HOSPITAL
Doing business as
EUREKA MEDICAL CLINIC AVERA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 2, 2019
Last certification
Jul 2, 2019
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jan 23, 1928 in SD
Enrollment address
200 J Ave
Ste a
Eureka, SD 57437-2225
Related CCNs
431308

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

Other NPIs with the same Medicare PAC ID 1

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
Eureka Community Benevolent Hospital Association

Locations

200 J Ave
Ste A
Eureka, SD 57437
Phone (605) 284-2621

410 9th St
Ste A
Eureka, SD 57437

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Lisa M Nesheim Individual W-2 Managing EmployeeClinic Manager Oct 1, 2016 10%
Kathryn M Gab Individual Corporate OfficerBoard Member Oct 1, 2016 10%
Keith a Kramlich Individual Corporate OfficerBoard Member Oct 1, 2016 10%
Carmen Louise Weber Individual Corporate OfficerCeo Oct 1, 2016 10%
Operational/Managerial ControlCeo Oct 1, 2016 10%
Wayne a Lutz Individual Corporate OfficerBoard Member Oct 1, 2016 10%
Eureka Community & Benevolent Hospital Organization, Eureka, SD Non-profit 5% Or Greater Direct Ownership Interest Oct 1, 2016 100%
Operational/Managerial Control Oct 1, 2016 100%
Patricia L Grenz Individual Corporate OfficerBoard Member Oct 1, 2016 10%
George B Hulscher Individual Corporate OfficerBoard Member Oct 1, 2016 10%
Wanda J Jundt Individual Corporate OfficerBoard Member Oct 1, 2016 10%
Stephanie M Raile Individual Corporate DirectorDirector of Health Info/Credenti Oct 1, 2016 10%
Staci Leigh Ackerman Individual Corporate DirectorDirector Nov 1, 2022

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Eureka Community Health ServicesEureka, SD, CCN 431308 Hospital 5% Or Greater Direct Ownership Interest (25%) Aug 13, 1996

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 9

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": "1468972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588291200000",
    "number": "1881047371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 517",
            "city": "EUREKA",
            "state": "SD",
            "postal_code": "574370517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 J AVE STE A",
            "city": "EUREKA",
            "state": "SD",
            "postal_code": "574372225",
            "telephone_number": "605-284-2661",
            "fax_number": "605-284-2054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EUREKA COMMUNITY & BENEVOLENT HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EUREKA COMMUNITY & BENEVOLENT HOSPITAL",
        "enumeration_date": "2016-07-20",
        "last_updated": "2020-05-01",
        "certification_date": "2020-05-01",
        "status": "A",
        "authorized_official_last_name": "WEBER",
        "authorized_official_first_name": "CARMEN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "605-284-2661"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eureka Community Health Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Eureka Medical Clinic Avera",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Eureka Medical Clinic Avera",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eureka, SD

Sources for this page

Verify at the official NPI Registry.