NPIMap

Organization Active NPI

Avera Queen of Peace

Doing business as Avera Weskota Memorial Medical Center Swing Bed Program

  • Medicare Defined Swing Bed Hospital Unit
  • Wessington Springs, SD
National Provider Identifier
1942205646
Registry record updated Aug 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
48209 Issued in SD
Legal business name
AVERA QUEEN OF PEACE
Doing business as
Avera Weskota Memorial Medical Center Swing Bed Program
Practice address
604 1St St NE
Wessington Springs, SD 57382-2134
Phone
(605) 539-1021
Fax
(605) 539-4580
NPI assigned
Jun 17, 2005
Last updated
Aug 20, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
AVERA QUEEN OF PEACEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 20, 2020

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

Authorized official

Name
Douglas Ekeren
Title
President/Ceo
Phone
(605) 668-8322

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 48209 SD Primary

Addresses

Primary practice location

604 1St St NE
Wessington Springs, SD 57382-2134

Mailing address

525 N Foster St
Mitchell, SD 57301-2966
Phone (605) 995-2000

Other identifiers 1

IdentifierTypeStateIssuer
0159082MedicaidSD

Other names 1

  • Avera Weskota Memorial Medical Center Swing Bed Program Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070130000357 SD Part A Provider - Critical Access Hospital 9335050806 Practice locations: Wessington Springs, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942205646. Details of each certification follow.

Hospital certification: CCN 43Z324

Legal name
AVERA QUEEN OF PEACE
Doing business as
AVERA WESKOTA MEMORIAL MEDICAL CENTER
Organization structure
CorporationNon-profit
Incorporated
Nov 1, 1908 in SD
Enrollment address
604 1St St NE
Wessington Springs, SD 57382-2166
Hospital Swing-Bed Unit

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

Other NPIs with the same Medicare PAC ID 11

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

National Provider Directory

National Provider Directory
Tax ID family
Avera Queen of Peace Ho29 organizations share this tax ID, including this one
Part of
Avera Queen of Peace Ho

Other organizations with this tax ID 28

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

View all 28

Ownership & related parties

All disclosed owners & managing parties 19

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
Trevor Dierks Individual Corporate DirectorBoard Member Jul 1, 2023
Julie Brookbank Individual Corporate DirectorBoard Member Jul 1, 2018
Tracey Larson Individual Corporate DirectorBoard Member Jul 1, 2019
Brad Zomer Individual Corporate DirectorBoard Member Jul 1, 2018
Jay Tolsma Individual Corporate DirectorBoard Member Jul 1, 2018
Diane Sandhoff Individual Corporate DirectorBoard Member Jul 1, 2023
Ryan Thompson Individual Corporate DirectorBoard Member Jul 1, 2018
Jennifer L Tegethoff Individual Corporate DirectorBoard Member Jul 1, 2021
Julie Lautt Individual Corporate OfficerCfo Jan 1, 2020
Hilary Rae Rockwell Individual Corporate OfficerPresident/Ceo Jul 1, 2023
Operational/Managerial Control Jul 1, 2023
Mark Puetz Individual Corporate DirectorBoard Member Jul 1, 2023
Avera Health Organization, Sioux Falls, SD Non-profit 5% Or Greater Direct Ownership Interest Jun 1, 2000 100%
Operational/Managerial Control Jun 1, 2000
Darlene Bergeleen Individual Corporate DirectorBoard Member Jul 1, 2023
Avera Queen of Peace Organization, Mitchell, SD Non-profit Operational/Managerial Control Jun 1, 2000
Jessica a Claussen Individual Corporate DirectorBoard Member Jul 1, 2021
Jean Koehler Individual Corporate DirectorBoard Member Jul 1, 2018
Mark Hunhoff Individual Corporate DirectorBoard Member Jul 1, 2019
Nicole Stahle Individual Corporate DirectorBoard Member Jul 1, 2023

Owners & managing parties with NPI records 14

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

View all 14

Facilities with the same owner 90

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

View all 90

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1118966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597881600000",
    "number": "1942205646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 N FOSTER ST",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573012966",
            "telephone_number": "605-995-2000",
            "fax_number": "605-995-2441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 1ST ST NE",
            "city": "WESSINGTON SPRINGS",
            "state": "SD",
            "postal_code": "573822134",
            "telephone_number": "605-539-1021",
            "fax_number": "605-539-4580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA QUEEN OF PEACE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AVERA QUEEN OF PEACE",
        "enumeration_date": "2005-06-17",
        "last_updated": "2020-08-20",
        "certification_date": "2020-08-20",
        "status": "A",
        "authorized_official_last_name": "EKEREN",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "605-668-8322"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "SD",
            "license": "48209",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0159082",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera Weskota Memorial Medical Center Swing Bed Program",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avera Weskota Memorial Medical Center Swing Bed Program",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wessington Springs, SD

Sources for this page

Verify at the official NPI Registry.