Coal Country Community Health Center

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

COAL COUNTRY COMMUNITY HEALTH CENTER

Practice address

111 Main St
Center, ND 58530-4712

Phone

(701) 794-8798

Fax

(701) 639-4707

NPI assigned

Dec 24, 2008

Last updated

Jan 8, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kurt Waldbillig

Title

Ceo

Phone

(701) 873-4445

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in ND3 enrollments

Enrollment records 3

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003052952. Details of each certification follow.

• CCN 351812 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 351812

Legal name

COAL COUNTRY COMMUNITY HEALTH CENTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Mar 10, 2004

Last certification

Mar 10, 2004

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Dec 1, 1996 in ND

Enrollment address

111 E Main St
Center, ND 58530-4712

Other NPIs with the same Medicare PAC ID 3

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

• Coal Country Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Killdeer, ND
  • NPI 1407235575

  9436042892

  Same PAC ID
• Coal Country Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Hazen, ND
  • NPI 1841658887

  9436042892

  Same PAC ID
• Coal Country Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Beulah, ND
  • NPI 1942288329

  9436042892

  Same PAC ID

Other NPIs on the same Medicare enrollment 4

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

• Coal Country Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Killdeer, ND
  • NPI 1407235575

  O20040317001173, O20191118000516

  Same enrollment
• Coal Country Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Hazen, ND
  • NPI 1841658887

  O20040317001173, O20191118000516

  Same enrollment
• Coal Country Community Health Center

  dba Sandhills Community Health Center

  • Family Medicine Physician
  • Towner, ND
  • NPI 1912143868

  O20040317001173

  Same enrollment
• Coal Country Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Beulah, ND
  • NPI 1942288329

  O20040317001173, O20090401000155, O20191118000516

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 17

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

Owners & managing parties with NPI records 2

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

• Donlyn Jay Erickson, D.C., C.C.S.P.

  • Chiropractor
  • Beulah, ND
  • NPI 1285668814

  Corporate Director, Corporate Officer

  CMS ownership
• Aaron Garman, M.D.

  • Family Medicine Physician
  • Beulah, ND
  • NPI 1457339939

  W-2 Managing Employee

  CMS ownership

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

{
    "created_epoch": "1230076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767830400000",
    "number": "1003052952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1312 HIGHWAY 49 N",
            "city": "BEULAH",
            "state": "ND",
            "postal_code": "585236038",
            "telephone_number": "701-873-7788",
            "fax_number": "701-639-4709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 MAIN ST",
            "city": "CENTER",
            "state": "ND",
            "postal_code": "585304712",
            "telephone_number": "701-794-8798",
            "fax_number": "701-639-4707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COAL COUNTRY COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-24",
        "last_updated": "2026-01-08",
        "certification_date": "2026-01-08",
        "status": "A",
        "authorized_official_last_name": "WALDBILLIG",
        "authorized_official_first_name": "KURT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "701-873-4445"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05912",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "6103001",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristy Lynn Bradley
• Dr. D. J. Trzpuc, DDS
• Raymond Hall, M.MGT, L/ATC, CSCS
• Anthony Joseph Heinze
• Leslie Rae Jackson-Heinze
• Ember Faith Kindsvogel

• Federally Qualified Health Center (FQHC) in Center, ND
• Providers in Center, ND by specialty
• Federally Qualified Health Center (FQHC) in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.