NPIMap

Organization Active NPI

Community Memorial Hospital Association

  • Critical Access Hospital
  • Cloquet, MN
National Provider Identifier
1003869082
Registry record updated Dec 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
331457 Issued in MN
Legal business name
COMMUNITY MEMORIAL HOSPITAL ASSOCIATION
Practice address
512 Skyline Blvd
Cloquet, MN 55720-3787
Phone
(218) 879-4641
Fax
(218) 879-4641
NPI assigned
May 18, 2006
Last updated
Dec 29, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2020

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

Authorized official

Name
Mr. Richard L Breuer
Title
Ceo/Administrator
Phone
(218) 878-7621

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X
Critical Access Hospital 282NC0060X 331457 MN Primary

Addresses

Primary practice location

512 Skyline Blvd
Cloquet, MN 55720-3787

Mailing address

512 Skyline Blvd
Cloquet, MN 55720-3787
Phone (218) 879-4641

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address hisdept@direct.cloquethospital.com
RESTful URL https://mtrestapis-live01.cmhmn.org/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040202001203 MN Part B Supplier - Clinic/Group Practice 0042129991 Receives reassigned benefits from 106 practitioners
Practice locations: Cloquet, MN
O20120706000189 MN Part A Provider - Critical Access Hospital 0042129991 Receives reassigned benefits from 147 practitioners
Practice locations: Cloquet, MN
O20190320003453 MN MDPP Supplier - in-Person MDPP Supplier 0042129991 Practice locations: Cloquet, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003869082. Details of each certification follow.

Hospital certification: CCN 241364

Legal name
COMMUNITY MEMORIAL HOSPITAL ASSOCIATION
Doing business as
COMMUNITY MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jan 1, 2005
Last certification
Jan 31, 2025
Beds
36 (25 certified)
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1960 in MN
Enrollment address
512 Skyline Blvd
Cloquet, MN 55720-3787
Main/Primary Hospital Location

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

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Community Memorial HospitalCCN 241364 · All quality measures
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

Locations

512 Skyline Blvd
Ste 1
Cloquet, MN 55720
Phone (218) 879-4641

Interoperability endpoints

  • Direct secure messaging: hisdept@direct.cloquethospital.com

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Lee R Olsen Individual Corporate DirectorBoard Member Dec 14, 2015
Stephen J Risacher Individual Corporate Director Jan 1, 2021
David E Hall Individual Corporate DirectorBoard Member Dec 14, 2015
Joanna M Robnik Individual Corporate Director Jan 1, 2019
Kirk D Johnson Individual Corporate OfficerCfo Jan 1, 2024
W-2 Managing EmployeeCfo Jan 1, 2024
Brad K Anderson Individual Corporate Officer Dec 1, 2001
W-2 Managing EmployeeCfo Dec 3, 2001 100%
Kara L Underwood Individual Corporate DirectorBoard Member Dec 16, 2016
Richard L Breuer Individual Corporate Director Sep 1, 1999
W-2 Managing EmployeeCeo / Administrator Sep 1, 1999 100%
Nancy Klassen Individual Corporate Director Jan 1, 2020
Kirk M Wimmer Individual Corporate Director Jan 1, 2019

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 164

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.

View all 164

Affiliated clinicians 178

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

View all 178

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609200000000",
    "number": "1003869082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 SKYLINE BLVD",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557203787",
            "telephone_number": "218-879-4641",
            "fax_number": "218-879-4641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 SKYLINE BLVD",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557203787",
            "telephone_number": "218-879-4641",
            "fax_number": "218-879-4641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEMORIAL HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2020-12-29",
        "certification_date": "2020-12-29",
        "status": "A",
        "authorized_official_last_name": "BREUER",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO/ADMINISTRATOR",
        "authorized_official_telephone_number": "218-878-7621",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MN",
            "license": "331457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hisdept@direct.cloquethospital.com",
            "affiliation": "N",
            "address_1": "512 Skyline Blvd Ste 1",
            "city": "Cloquet",
            "state": "MN",
            "country_code": "US",
            "postal_code": "557201199",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "REST",
            "endpointTypeDescription": "RESTful URL",
            "endpoint": "https://mtrestapis-live01.cmhmn.org/",
            "affiliation": "N",
            "address_1": "512 Skyline Blvd Ste 1",
            "city": "Cloquet",
            "state": "MN",
            "country_code": "US",
            "postal_code": "557201199",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cloquet, MN

Sources for this page

Verify at the official NPI Registry.