NPIMap

Organization Active NPI

Avera St Marys

Doing business as Avera St. Mary's Hospital Swingbed

  • Medicare Defined Swing Bed Hospital Unit
  • Pierre, SD
National Provider Identifier
1992713457
Registry record updated Jul 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
43U015 Issued in SD
Legal business name
AVERA ST MARYS
Doing business as
Avera St. Mary's Hospital Swingbed
Practice address
801 East Sioux Ave
Pierre, SD 57501-3323
Phone
(605) 224-3100
Fax
(605) 224-8339
NPI assigned
Aug 3, 2006
Last updated
Jul 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2022

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

Authorized official

Name
Mikel Holland
Title
Ceo/President
Phone
(605) 224-3144

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 43U015 SD Primary

Addresses

Primary practice location

801 East Sioux Ave
Pierre, SD 57501-3323

Mailing address

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

Other names 1

  • Avera St. Mary's Hospital Swingbed Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100909001268 SD Part A Provider - Hospital 0143134965 1 other NPI on this enrollment
Practice locations: Pierre, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992713457. Details of each certification follow.

Hospital certification: CCN 43U015

Legal name
AVERA ST MARYS
Doing business as
AVERA ST MARYS HOSPITAL - SWINGBED
Organization structure
CorporationNon-profit
Incorporated
Feb 10, 1951 in SD
Enrollment address
801E Sioux Ave
Avera St Marys Hospital Swingbed
Pierre, SD 57501-3323
Hospital Swing-Bed Unit
Hospital subgroups
Swing-bed approved

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

Other NPIs with the same Medicare PAC ID 5

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

  • Avera St Marys

    dba Avera Maryhouse Long Term Care

    • Skilled Nursing Facility
    • Pierre, SD
    • NPI 1063654648

    0143134965

    Same PAC ID
  • Avera St Marys

    dba Avera St Marys Hospital - ESRD

    • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
    • Pierre, SD
    • NPI 1144238619

    0143134965

    Same PAC ID
  • Avera St Marys

    dba Avera St. Mary's Hospital

    • General Acute Care Hospital
    • Pierre, SD
    • NPI 1669457180

    0143134965

    Same PAC ID
  • Avera St Marys

    dba Avera Pierre Clinic

    • Multi-Specialty Clinic/Center
    • Pierre, SD
    • NPI 1720326713

    0143134965

    Same PAC ID
  • Avera St. Mary's

    dba Avera St. Mary's Campus Pharmacy

    • Community/Retail Pharmacy
    • Pierre, SD
    • NPI 1932651122

    0143134965

    Same PAC ID

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Jon Vandermaten PA C11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Robert Wylie Individual Corporate DirectorBoard Member Jul 1, 2021
Amy Kathryn Lueking Individual Corporate DirectorBoard Member Jul 1, 2021
Kimberly Olson Individual Corporate DirectorBoard Member Jul 1, 2022
Michael Weisgram Individual Corporate DirectorBoard Member Jul 1, 2017
Meredith Lee Individual Corporate DirectorBoard Member Jul 1, 2022
Penny Bingham Individual Corporate DirectorBoard Member Jul 1, 2018
Lynn Marie Welbig Individual Corporate DirectorBoard Member Jul 1, 2017
Jami Kay Cronin Individual Corporate DirectorBoard Member Jul 1, 2021
Shantel Shamiele Krebs Individual Corporate OfficerPresident/Ceo Mar 13, 2023
Operational/Managerial Control Mar 13, 2023
Bobby Lynn Sutton Individual Corporate OfficerPresident/Ceo Avera Health Jun 18, 2018
Mark L Hagy Individual Corporate DirectorBoard Member Jul 1, 2022
Michael Larson Individual Corporate DirectorBoard Member Jul 1, 2020
Avera Health Organization, Sioux Falls, SD Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2013 100%
Operational/Managerial Control Jan 1, 2013
Kristin Brost Individual Corporate DirectorBoard Member Jul 1, 2021

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Avera Missouri River Health CenterGettysburg, SD, CCN 431302 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2013
Avera Missouri River Health CenterGettysburg, SD, CCN 43Z302 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2013

Owned or controlled facilities with NPI records 2

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

  • Avera Gettysburg

    dba Avera Missouri River Health Center

    • Critical Access Hospital
    • Gettysburg, SD
    • NPI 1003887266

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Avera Gettysburg

    dba Avera Missouri River Health Center (Swingbed)

    • Medicare Defined Swing Bed Hospital Unit
    • Gettysburg, SD
    • NPI 1881754497

    5% Or Greater Direct Ownership Interest

    CMS ownership

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 1

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.

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": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657843200000",
    "number": "1992713457",
    "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",
            "fax_number": "605-322-6499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 EAST SIOUX AVE",
            "city": "PIERRE",
            "state": "SD",
            "postal_code": "575013323",
            "telephone_number": "605-224-3100",
            "fax_number": "605-224-8339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVERA ST MARYS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-15",
        "status": "A",
        "authorized_official_last_name": "HOLLAND",
        "authorized_official_first_name": "MIKEL",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "605-224-3144"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "SD",
            "license": "43U015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avera St. Mary's Hospital Swingbed",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avera St. Mary's Hospital Swingbed",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pierre, SD

Sources for this page

Verify at the official NPI Registry.