NPIMap

Organization Active NPI

Hendricks Community Hospital Assn & Retirement Home

Doing business as Hendricks Clinic

  • Rural Health Clinic/Center
  • Hendricks, MN
National Provider Identifier
1013206812
Registry record updated Aug 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HENDRICKS COMMUNITY HOSPITAL ASSN & RETIREMENT HOME
Doing business as
Hendricks Clinic
Practice address
501 E Lincoln St
Hendricks, MN 56136-9598
Phone
(507) 275-3121
Fax
(507) 275-3194
NPI assigned
Apr 1, 2011
Last updated
Aug 27, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
HENDRICKS COMMUNITY HOSPITAL ASSOCIATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 27, 2012

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

Authorized official

Name
Mr. Jeff Gollaher
Title
Ceo
Phone
(507) 275-3134

Specialties & licenses 1

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

Addresses

Primary practice location

501 E Lincoln St
Hendricks, MN 56136-9598

Mailing address

501 E Lincoln St
PO Box 106
Hendricks, MN 56136-9598
Phone (507) 275-3134

Other names 1

  • Hendricks Clinic Doing business as

Medicare participation

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

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20110602000620 MN Part B Supplier - Clinic/Group Practice 9830127356 Receives reassigned benefits from 7 practitioners
1 other NPI on this enrollment
Practice locations: Hendricks, MN; Ivanhoe, MN
O20110622000734 MN Part A Provider - Rural Health Clinic 9830127356 1 other NPI on this enrollment
Practice locations: Hendricks, MN
O20110623000542 MN Part A Provider - Rural Health Clinic 9830127356 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ivanhoe, MN

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1013206812. Details of each certification follow.

Rural health clinic certification: CCN 243455

Legal name
HENDRICKS COMMUNITY HOSPITAL ASSN & RETIREMENT HOME
Doing business as
HENDRICKS CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 1, 2011
Last certification
Sep 10, 2012
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Feb 25, 1941 in MN
Enrollment address
501 E Lincoln St
Hendricks, MN 56136-9598
Related CCNs
241339

Rural health clinic certification: CCN 243457

Legal name
HENDRICKS COMMUNITY HOSPITAL ASSN & RETIREMENT HOME
Doing business as
IVANHOE MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 23, 2012
Last certification
Jan 6, 2012
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Feb 25, 1941 in MN
Enrollment address
315 N Norman St
Ivanhoe, MN 56142-9580
Related CCNs
241339

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

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 1

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

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
24D0405219Hendricks Community Hospital Assn501 East Lincoln Street, Hendricks, MN 56136Provider-performed microscopyAug 31, 2026

National Provider Directory

National Provider Directory
Part of
Hendricks Community Hospital Association

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
Mark Vaneck Individual Corporate DirectorBoard Member Apr 1, 2011
Dawn Popowski Individual Corporate DirectorBoard Member Jan 1, 2019
Amy Heidi Fier Individual Corporate DirectorBoard Member Aug 26, 2023
Travis Olsen Individual Corporate OfficerCeo Jan 1, 2025 100%
W-2 Managing EmployeeAd; Aug 1, 2020 100%
Vince Robinson Individual Corporate DirectorBoard Member Apr 1, 2011
James Ness Individual Corporate DirectorBoard Member Aug 27, 2015
Brittany Johnson Individual Corporate DirectorBoard Member Aug 26, 2023
John Engels Individual Corporate DirectorBoard Member Aug 24, 2017
Allen Molascon Individual Corporate DirectorBoard Member Apr 1, 2011
Heather Shaw Individual Corporate DirectorBoard Member Aug 26, 2023

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1301616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346025600000",
    "number": "1013206812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 E LINCOLN ST",
            "address_2": "PO BOX 106",
            "city": "HENDRICKS",
            "state": "MN",
            "postal_code": "561369598",
            "telephone_number": "507-275-3134",
            "fax_number": "507-275-2242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 E LINCOLN ST",
            "city": "HENDRICKS",
            "state": "MN",
            "postal_code": "561369598",
            "telephone_number": "507-275-3121",
            "fax_number": "507-275-3194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENDRICKS COMMUNITY HOSPITAL ASSN & RETIREMENT HOME",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HENDRICKS COMMUNITY HOSPITAL ASSOCIATION",
        "enumeration_date": "2011-04-01",
        "last_updated": "2012-08-27",
        "status": "A",
        "authorized_official_last_name": "GOLLAHER",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "507-275-3134",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hendricks Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hendricks, MN

Sources for this page

Verify at the official NPI Registry.