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Organization Active NPI

Avera Holy Family

Doing business as Avera Holy Family Hospital

  • Critical Access Hospital
  • Estherville, IA
National Provider Identifier
1891738365
Registry record updated Jul 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
320014H Issued in IA
Legal business name
AVERA HOLY FAMILY
Doing business as
Avera Holy Family Hospital
Practice address
826 N 8TH St
Estherville, IA 51334-1528
Phone
(712) 362-2631
Fax
(712) 362-2636
NPI assigned
Jun 13, 2006
Last updated
Jul 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2021

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

Authorized official

Name
Deb Herzberg
Title
Ceo
Phone
(712) 362-6160

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 320014H IA Primary

Addresses

Primary practice location

826 N 8TH St
Estherville, IA 51334-1528

Mailing address

826 N 8TH St
Estherville, IA 51334-1528
Phone (712) 362-2631

Other identifiers 2

IdentifierTypeStateIssuer
66002OtherIAWELLMARK IA SWING BED
0655845MedicaidIA

Other names 1

  • Avera Holy Family Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070131000514 IA Part A Provider - Critical Access Hospital 7113837428 Practice locations: Estherville, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891738365. Details of each certification follow.

Hospital certification: CCN 16Z351

Legal name
AVERA HOLY FAMILY
Doing business as
AVERA HOLY FAMILY HOSPITAL
Organization structure
CorporationNon-profit
Enrollment address
826 N 8TH St
Estherville, IA 51334-1528

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

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Holy Family Hospital5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

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
James Francis Dover Individual Corporate OfficerFache, President/Ceo Avera Health Oct 23, 2023
Avera McKennan Organization, Sioux Falls, SD Corporation, Non-profit Operational/Managerial Control Jan 1, 2007
Candyce C Chrystal Individual Corporate DirectorBoard Member Jul 1, 2022
Mike Cornwall Individual Corporate DirectorBoard Member Jul 1, 2018
Edward James Rosendahl Individual Corporate DirectorBoard Member Jul 1, 2023
Yas Mata Individual Corporate DirectorBoard Member Jul 1, 2022
Robert Jensen Individual Corporate DirectorBoard Member Jul 1, 2022
Penny Clayton Individual Corporate DirectorBoard Member Jul 1, 2023
Michelle Majerus Individual Corporate OfficerCeo Sep 30, 2024
W-2 Managing EmployeeCeo Sep 30, 2024
Operational/Managerial ControlCeo Sep 30, 2024
Avera Health Organization, Sioux Falls, SD Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2000 100%
Operational/Managerial Control Jan 1, 2000
Janet K Schumacher Individual Corporate DirectorBoard Member Jul 1, 2020

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Avera Holy Family HospitalEstherville, IA, CCN 161351 Hospital Operational/Managerial Control Nov 20, 2007

Owned or controlled facilities with NPI records 1

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

  • Avera Holy Family

    dba Avera Holy Family Hospital

    • Critical Access Hospital
    • Estherville, IA
    • NPI 1508810177

    Operational/Managerial Control

    CMS ownership

Facilities with the same owner 97

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

View all 97

Practitioners & affiliated clinicians

Affiliated clinicians 6

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

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625184000000",
    "number": "1891738365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "826 N 8TH ST",
            "city": "ESTHERVILLE",
            "state": "IA",
            "postal_code": "513341528",
            "telephone_number": "712-362-2631",
            "fax_number": "712-362-2636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "826 N 8TH ST",
            "city": "ESTHERVILLE",
            "state": "IA",
            "postal_code": "513341528",
            "telephone_number": "712-362-2631",
            "fax_number": "712-362-2636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA HOLY FAMILY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-13",
        "last_updated": "2021-07-02",
        "certification_date": "2021-07-02",
        "status": "A",
        "authorized_official_last_name": "HERZBERG",
        "authorized_official_first_name": "DEB",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "712-362-6160"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IA",
            "license": "320014H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK IA SWING BED",
            "identifier": "66002",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0655845",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Holy Family Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avera Holy Family Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Estherville, IA

Sources for this page

Verify at the official NPI Registry.