Avera Gettysburg
Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Gettysburg, SD
NPI 1881754497 · NPPES record last updated Jul 15, 2022
Key facts
- NPI
- 1881754497
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medicare Defined Swing Bed Hospital Unit 275N00000X
- License
- 10542 (SD)
- Legal business name
- AVERA GETTYSBURG
- Practice address
- 606 E Garfield Ave
Gettysburg, SD 57442-1325 - Phone
- (605) 765-2488
- Fax
- (605) 765-2704
- NPI assigned
- Dec 12, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Mikel Holland
- Title
- Ceo/President
- Phone
- (605) 224-3144
Owners & managing parties with NPI records 10
-
Debra Ann Kolecka, CNP
-
Rena J Robbennolt, CNP
-
Mark Lindsay Hagy, M.D.
-
Amy Lueking, MD
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 2
Member of 1
Related certifications (CCN) 1
Facilities with the same owner 90
Practitioners 14
-
Connie Belford, C.N.P.
-
Rena J Robbennolt, CNP
-
Chad J Carda, MD
-
Cindy D. Erwin, P.A.-C.
-
Stephen John Knoble, PA-C
-
Riley Aaron Lamb, M.D.
-
Darci Leisenring, CNP
-
Meghan Jeane Torgerson, FNP-C
-
Heather Olson, PA-C
Affiliated clinicians 5
-
Connie Belford, C.N.P.
-
Chad J Carda, MD
-
Darci Leisenring, CNP
-
Meghan Jeane Torgerson, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SD
Hospital certification: CCN 43Z302
- Legal name
- AVERA GETTYSBURG
- Doing business as
- AVERA MISSOURI RIVER HEALTH CENTER
- Organization structure
- Corporation · Non-profit
- Incorporated
- Sep 7, 1957 in SD
- Enrollment address
- 606 E Garfiled Ave
Gettysburg, SD 57442-1325
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Avera St Marys |
5% Or Greater Direct Ownership Interest | Jan 1, 2013 | 100% |
| James Francis Dover |
Corporate Officer |
Oct 23, 2023 | |
| Robert Wylie |
Corporate Director |
Jul 1, 2021 | |
| Amy Kathryn Lueking |
Corporate Director |
Jul 1, 2021 | |
| Debra Ann Kolecka |
Corporate Director |
Jul 1, 2023 | |
| Kimberly Olson |
Corporate Director |
Jul 1, 2022 | |
| Michael Weisgram |
Corporate Director |
Jul 1, 2015 | |
| Rena J Robbennolt |
Corporate Director |
Jul 1, 2023 | |
| Meredith Lee |
Corporate Director |
Jul 1, 2022 | |
| Julie Lautt |
Corporate Officer |
Mar 1, 2020 | |
| Lynn Marie Welbig |
Corporate Director |
Jul 1, 2018 | |
| Jami Kay Cronin |
Corporate Director |
Jul 1, 2021 | |
| Shantel Shamiele Krebs |
Corporate Officer |
Mar 13, 2023 | |
| Operational/Managerial Control | Mar 13, 2023 | ||
| Mark L Hagy |
Corporate Director |
Jul 1, 2022 | |
| Avera Health |
5% Or Greater Indirect Ownership Interest | Jan 1, 2013 | 100% |
| Kristin Brost |
Corporate Director |
Jul 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070129000187 | SD | Part a Provider - Critical Access Hospital | 4284619362 | Practice locations: Gettysburg, SD |
National Provider Directory
- Tax ID family
- Avera Gettysburg
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | 10542 | SD | Yes |
Addresses
Primary practice location
606 E Garfield Ave
Gettysburg, SD 57442-1325
Mailing address
606 E Garfield Ave
Gettysburg, SD 57442-1325
Phone (605) 765-2488
Other names
- Avera Missouri River Health Center (Swingbed)
Other providers in Gettysburg, SD
- Avera Gettysburg
- Avera Gettysburg
- Avera Gettysburg
- Jenny Renee Beetsch
- Connie Belford
- Ethan David Burdman
- City of Gettysburg
- Community Pharmacies Inc
All providers in Gettysburg, 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 Jul 15, 2022. 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.