NPIMap

Organization Active NPI

Mobridge Regional Hospital

Doing business as Hospital Ambulance

  • Critical Access Hospital
  • Mobridge, SD
National Provider Identifier
1902948896
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
Doing business as
Hospital Ambulance
Practice address
1401 10TH Ave W
Mobridge, SD 57601
Phone
(605) 845-3692
Fax
(605) 845-8252
NPI assigned
Feb 14, 2007
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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 48404 SD Primary

Addresses

Primary practice location

1401 10TH Ave W
Mobridge, SD 57601

Mailing address

1401 10TH Ave W
Mobridge, SD 57601
Phone (605) 845-3692

Other identifiers 1

IdentifierTypeStateIssuer
9010600MedicaidSD

Other names 1

  • Hospital Ambulance Doing business as

Medicare participation

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

Enrollment records 1

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
This NPI is an additional NPI on the enrollment
Practice locations: Mobridge, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902948896. 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 on the same Medicare enrollment 1

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
Tax ID family
Mobridge Regional Hospi9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the 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 21

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 21

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": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475712000000",
    "number": "1902948896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 10TH AVE W",
            "city": "MOBRIDGE",
            "state": "SD",
            "postal_code": "57601",
            "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 W",
            "city": "MOBRIDGE",
            "state": "SD",
            "postal_code": "57601",
            "telephone_number": "605-845-3692",
            "fax_number": "605-845-8252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBRIDGE REGIONAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "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": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "SD",
            "license": "48404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9010600",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hospital Ambulance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mobridge, SD

Sources for this page

Verify at the official NPI Registry.