NPIMap

Organization Active NPI

Jacobson Memorial Hospital Care Center

  • Rural Health Clinic/Center
  • Glen Ullin, ND
National Provider Identifier
1003929944
Registry record updated Jan 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
JACOBSON MEMORIAL HOSPITAL CARE CENTER
Practice address
602 Ash Ave E
Glen Ullin, ND 58631
Phone
(701) 584-2792
NPI assigned
Aug 16, 2006
Organization subpart
Yes
Parent organization
JACOBSON MEMORIAL HOSPITAL CARE CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 26, 2026

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

Authorized official

Name
Kristin Heid
Title
Ceo
Phone
(701) 584-7205

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

602 Ash Ave E
Glen Ullin, ND 58631

Mailing address

PO Box 367
Elgin, ND 58533-0367
Phone (701) 584-2792

Other identifiers 2

IdentifierTypeStateIssuer
06043003OtherNDBLUE CROSS - RHC
1458638MedicaidND

Other names 1

  • Glen Ullin Family Medical Clinic Doing business as

Owned or controlled facilities with NPI records 2

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

Other NPIs on the same Medicare enrollment 2

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

Other NPIs with the same Medicare PAC ID 4

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

Practitioners 20

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

View all 20

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
35D1046042Glen Ullin Family Medical Clinic602 E Ash Ave, Glen Ullin, ND 58631Certificate of waiverSep 28, 2027

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031210001025 ND Part B Supplier - Clinic/Group Practice 2466363981 Receives reassigned benefits from 25 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Elgin, ND; Glen Ullin, ND; Richardton, ND
O20061130000152 ND Part A Provider - Rural Health Clinic 2466363981 Practice locations: Glen Ullin, ND

Rural health clinic certification: CCN 353449

Legal name
JACOBSON MEMORIAL HOSPITAL CARE CENTER
Doing business as
GLEN ULLIN FAMILY MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 1, 2006
Last certification
Jun 10, 2019
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Apr 22, 1946 in ND
Enrollment address
602 E Ash Ave
Glen Ullin, ND 58631-7138
Related CCNs
351314

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

All disclosed owners & managing parties 11

Medicare enrollment files

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

NameRoleSinceShare
Joann Schatz Individual Corporate Director Feb 9, 2023
Leona Zemliska Individual Corporate OfficerVice Chair Feb 9, 2023
Dennis Sabin Individual Corporate Director Nov 9, 2018
Dennis Rivinius Individual Corporate Director Feb 9, 2023
Stephanie Labrie Individual W-2 Managing EmployeeCfo Sep 13, 2023
Dave Marion Individual Corporate Director Feb 9, 2023
Matt Hager Individual Corporate Director Feb 4, 2025
Kristin Heid Individual Corporate OfficerCoo Jun 15, 2023
W-2 Managing EmployeeCoo Sep 26, 2002
Operational/Managerial ControlCoo Jun 15, 2023
Ann Hertz Individual Corporate Director Nov 9, 2018
Ronald Bartz Individual Corporate OfficerPresident Nov 20, 2013
Patrick Diehl Individual Corporate DirectorSecretary Nov 9, 2018

All facility ownership & control disclosures 2

Medicare enrollment files

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

FacilityTypeRoleSince
Marian Manor Health Care CenterGlen Ullin, ND, CCN 355036 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Oct 13, 2022
Oct 13, 2022
Jacobson Memorial Hospital Care CenterRichardton, ND, CCN 353460 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2019

National Provider Directory

National Provider Directory
Part of
Jacobson Memorial Hospital

NPI Registry JSON

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769385600000",
    "number": "1003929944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 367",
            "city": "ELGIN",
            "state": "ND",
            "postal_code": "585330367",
            "telephone_number": "701-584-2792",
            "fax_number": "701-584-2229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 ASH AVE E",
            "city": "GLEN ULLIN",
            "state": "ND",
            "postal_code": "58631",
            "telephone_number": "701-584-2792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACOBSON MEMORIAL HOSPITAL CARE CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JACOBSON MEMORIAL HOSPITAL CARE CENTER",
        "enumeration_date": "2006-08-16",
        "last_updated": "2026-01-26",
        "certification_date": "2026-01-26",
        "status": "A",
        "authorized_official_last_name": "HEID",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "701-584-7205"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS - RHC",
            "identifier": "06043003",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1458638",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glen Ullin Family Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glen Ullin, ND

Sources for this page

Verify at the official NPI Registry.