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Organization Active NPI

Bowdle Hospital

  • Rural Health Clinic/Center
  • Bowdle, SD
National Provider Identifier
1942395835
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BOWDLE HOSPITAL
Practice address
8001 West 5TH Street
Bowdle, SD 57428
Phone
(605) 285-6832
Fax
(605) 285-6986
NPI assigned
Oct 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Jon Kosiak
Title
Ceo
Phone
(605) 285-6146

Specialties & licenses 1

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

Addresses

Primary practice location

8001 West 5TH Street
Bowdle, SD 57428

Mailing address

P.O. Box 556
Bowdle, SD 57428-0556
Phone (605) 285-6146

Other identifiers 1

IdentifierTypeStateIssuer
5340200MedicaidSD

Other names 1

  • Bowdle Rural Health Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20021010000032 SD Part A Provider - Rural Health Clinic 9335056902 Practice locations: Bowdle, SD
O20040325001225 SD Part B Supplier - Clinic/Group Practice 9335056902 Receives reassigned benefits from 6 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bowdle, SD

Rural health clinic certification: CCN 433419

Legal name
BOWDLE HOSPITAL
Doing business as
BOWDLE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 1, 2003
Last certification
Nov 8, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Dec 22, 2003 in SD
Enrollment address
8001 W 5TH St
Bowdle, SD 57428-2031
Related CCNs
431318

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).

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Bowdle 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 8

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

NameRoleSinceShare
Russell Maier Individual Corporate Officer May 1, 2023
City of Bowdle Organization, Bowdle, SD 5% Or Greater Direct Ownership Interest Sep 3, 2002 100%
Margaret Bobby Individual Corporate Officer May 1, 2022
Amber Shaykett Individual Corporate Officer Sep 1, 2022
Darwyn Kleffman Individual Corporate OfficerCeo May 20, 2019
W-2 Managing EmployeeCeo May 20, 2019
Michael Gunderson Individual Corporate DirectorBoard Member May 1, 2017
Rick Boschee Individual Corporate DirectorChairman Nov 25, 2002
Rex Gab Individual Corporate DirectorBoard Member May 2, 2016

Facilities with the same owner 3

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

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1942395835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 556",
            "city": "BOWDLE",
            "state": "SD",
            "postal_code": "574280556",
            "telephone_number": "605-285-6146",
            "fax_number": "605-285-6410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8001 WEST 5TH STREET",
            "city": "BOWDLE",
            "state": "SD",
            "postal_code": "57428",
            "telephone_number": "605-285-6832",
            "fax_number": "605-285-6986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOWDLE HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KOSIAK",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "605-285-6146",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5340200",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bowdle Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bowdle, SD

Sources for this page

Verify at the official NPI Registry.