NPIMap

Organization Active NPI

Northwood Deaconess Health Center

  • Medicare Defined Swing Bed Hospital Unit
  • Northwood, ND
National Provider Identifier
1003913518
Registry record updated May 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
NORTHWOOD DEACONESS HEALTH CENTER
Practice address
4 N Park St
Northwood, ND 58267-4102
Phone
(701) 587-6060
Fax
(701) 587-6492
NPI assigned
Sep 19, 2006
Last updated
May 27, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2025

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

Authorized official

Name
Brock Sherva
Title
Ceo
Phone
(701) 587-6060

Specialties & licenses 1

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

Addresses

Primary practice location

4 N Park St
Northwood, ND 58267-4102

Mailing address

PO Box 190
Northwood, ND 58267-0190
Phone (701) 587-6060

Other identifiers 2

IdentifierTypeStateIssuer
1000064OtherMEDICARE PART B
DO1918MedicaidND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040226000123 ND Part B Supplier - Clinic/Group Practice 1052207057 Receives reassigned benefits from 22 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Northwood, ND
O20080429000205 ND Part A Provider - Critical Access Hospital 1052207057 Practice locations: Northwood, ND

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003913518. Details of each certification follow.

Hospital certification: CCN 35Z312

Legal name
NORTHWOOD DEACONESS HEALTH CENTER
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1990 in ND
Enrollment address
4 N Park St
Northwood, ND 58267-4102

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 5

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Northwood Deaconess Health Center Organization, Northwood, ND Non-profit Operational/Managerial Control Jan 1, 1990
Keith Groven Individual Corporate Director Mar 26, 2018
Judy Engen Individual Corporate Director Mar 26, 2019
Lonney Eastvold Individual Corporate Director Mar 26, 2018
Peter L Antonson Individual Corporate OfficerCeo May 12, 2000
Operational/Managerial ControlCeo May 12, 2000
Joan Thompson Individual Corporate Director Mar 30, 2021
Greg McMahon Individual Corporate Director Mar 26, 2019
Patrick Askew Individual Corporate Director Jan 25, 2022
Robert Bilden Individual Corporate Director Mar 27, 2010

Owners & managing parties with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 2

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 1

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": "1158624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748304000000",
    "number": "1003913518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190",
            "city": "NORTHWOOD",
            "state": "ND",
            "postal_code": "582670190",
            "telephone_number": "701-587-6060",
            "fax_number": "701-587-6492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 N PARK ST",
            "city": "NORTHWOOD",
            "state": "ND",
            "postal_code": "582674102",
            "telephone_number": "701-587-6060",
            "fax_number": "701-587-6492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWOOD DEACONESS HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-19",
        "last_updated": "2025-05-27",
        "certification_date": "2025-05-27",
        "status": "A",
        "authorized_official_last_name": "SHERVA",
        "authorized_official_first_name": "BROCK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "701-587-6060"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "1000064",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DO1918",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Northwood, ND

Sources for this page

Verify at the official NPI Registry.