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Organization Active NPI

Avera Queen of Peace

  • Critical Access Hospital
  • Mitchell, SD
National Provider Identifier
1992466635
Registry record updated Jan 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
AVERA QUEEN OF PEACE
Practice address
525 N Foster St
Mitchell, SD 57301-2966
Phone
(605) 995-2000
NPI assigned
Jan 5, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2022

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X Primary

Addresses

Primary practice location

525 N Foster St
Mitchell, SD 57301-2966

Mailing address

PO Box 5045 Attn Prvenrolmt Palm Place BLDG
Sioux Falls, SD 57117-5045
Phone (605) 322-6428

Other names 1

  • AVERA QUEEN OF PEACE HOSPITAL Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031229000301 SD Part B Supplier - Clinic/Group Practice 9335050806 Receives reassigned benefits from 252 practitioners
31 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mitchell, SD; Parkston, SD; Pierre, SD; Platte, SD; Sioux Falls, SD; Wagner, SD; Wessington Springs, SD; Yankton, SD…
O20220301001771 SD Part A Provider - Critical Access Hospital 9335050806 Receives reassigned benefits from 99 practitioners
Practice locations: Mitchell, SD

Hospital certification: CCN 431340

Legal name
AVERA QUEEN OF PEACE
Doing business as
AVERA QUEEN OF PEACE HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jul 21, 2022
Last certification
Jul 21, 2022
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Nov 1, 1908 in SD
Enrollment address
525 N Foster St
Mitchell, SD 57301-2966
Main/Primary Hospital Location

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).

Other NPIs on the same Medicare enrollment 31

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

View all 31

Care Compare: Hospital

Medicare Care Compare
Listed as
Avera Queen of PeaceCCN 431340
Overall star rating
4 of 5
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
ER Phy29 organizations share this tax ID, including this one

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
Brad Zomer Individual Corporate DirectorBoard Member Jul 1, 2021
Diane Sandhoff Individual Corporate DirectorBoard Member Jul 1, 2023
Fredel Thomas Individual Corporate DirectorBoard Member Jul 1, 2024
Ryan Thompson Individual Corporate DirectorBoard Member Jul 1, 2021
Joyce Feteral Individual Corporate DirectorBoard Member Jul 1, 2024
Amanda Marie Schutz Individual Corporate OfficerOfficer Billing Services Jul 21, 2022
Vicky Larson Individual Corporate DirectorBoard Member Jul 1, 2024
Ann Buckmiller Individual Corporate DirectorBoard Member Jul 1, 2025
Jennifer L Tegethoff Individual Corporate DirectorBoard Member Jul 1, 2021
Julie Lautt Individual Corporate OfficerCfo Mar 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 Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2011 100%
Operational/Managerial Control Jan 1, 2011
Darlene Bergeleen Individual Corporate DirectorBoard Member Jul 1, 2023
Jessica a Claussen Individual Corporate DirectorBoard Member Jul 1, 2021
Mark Hunhoff Individual Corporate DirectorBoard Member Jul 1, 2021
Nicole Stahle Individual Corporate DirectorBoard Member Jul 1, 2023

Owners & managing parties with NPI records 3

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

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 Weskota Memorial Medical CenterWessington Springs, SD, CCN 43Z324 Hospital Operational/Managerial Control Jun 1, 2000

Owned or controlled facilities with NPI records 1

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

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

Practitioners 170

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 170

Affiliated clinicians 191

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

View all 191

NPI Registry JSON

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

{
    "created_epoch": "1641340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641340800000",
    "number": "1992466635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5045 ATTN PRVENROLMT PALM PLACE BLDG",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175045",
            "telephone_number": "605-322-6428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 N FOSTER ST",
            "city": "MITCHELL",
            "state": "SD",
            "postal_code": "573012966",
            "telephone_number": "605-995-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA QUEEN OF PEACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-05",
        "last_updated": "2022-01-05",
        "certification_date": "2022-01-05",
        "status": "A",
        "authorized_official_last_name": "EKEREN",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "605-668-8322"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AVERA QUEEN OF PEACE HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mitchell, SD

Sources for this page

Verify at the official NPI Registry.