NPIMap

Organization Active NPI

Tioga Medical Center

  • Rural Health Clinic/Center
  • Ray, ND
National Provider Identifier
1013981893
Registry record updated Sep 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
TIOGA MEDICAL CENTER
Practice address
Ray Mini Mall
Railroad Ave
Ray, ND 58849
Phone
(701) 568-3624
NPI assigned
Feb 16, 2006
Last updated
Sep 9, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2008

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

Authorized official

Name
Randall K. Pederson
Title
President/Ceo
Phone
(701) 664-3305

Specialties & licenses 1

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

Addresses

Primary practice location

Ray Mini Mall
Railroad Ave
Ray, ND 58849

Mailing address

PO Box 159
Tioga, ND 58852-0159
Phone (701) 664-3305

Other identifiers 2

IdentifierTypeStateIssuer
5024MedicaidND
8557OtherNDBCBSND

Other names 1

  • Tioga Medical Center-Ray RHC Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050706000079 ND Part A Provider - Rural Health Clinic 1254390305 Practice locations: Ray, ND

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013981893. Details of each certification follow.

Rural health clinic certification: CCN 353988

Legal name
TIOGA MEDICAL CENTER
Doing business as
TIOGA MEDICAL CENTER-RAY RHC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 11, 1992
Last certification
Jan 6, 2026
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jul 29, 1960 in ND
Enrollment address
25 Railroad Ave
Ray, ND 58849
Related CCNs
351300

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).

National Provider Directory

National Provider Directory
Tax ID family
Tioga Med Ctr Clinic8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Tioga Medical Center Organization, Tioga, ND Non-profit Operational/Managerial Control Apr 15, 1992 100%
Seth Wisthoff Individual Corporate DirectorDirector Mar 18, 2019
James W Booth Individual Corporate DirectorChairman Mar 18, 2013
Wendy Lenzen Individual Corporate DirectorSecretary/Treasurer Mar 20, 2023
Patrick Joyce Individual Corporate DirectorDirector Mar 20, 2023
Kristopher Kuehn Individual Corporate DirectorDirector Mar 20, 2023
Jeremy Becker Individual Corporate DirectorDirector Mar 18, 2019
Lee a Olson Individual Corporate DirectorDirector Mar 20, 2017
Holly Bryant Individual Corporate OfficerChief Financial Officer Feb 21, 2023
W-2 Managing EmployeeChief Financial Officer Feb 21, 2023
Operational/Managerial ControlChief Financial Officer Feb 21, 2023
Jamie Eraas Individual Corporate OfficerChief Executive Officer Jan 27, 2023
W-2 Managing EmployeeChief Executive Officer Jan 27, 2023
Operational/Managerial ControlChief Executive Officer Jan 27, 2023
Nathan Germundson Individual Corporate DirectorDirector Mar 16, 2020
Brodie Odegaard Individual Corporate DirectorVice-Chairman Mar 20, 2017

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Tioga Medical Center LTCTioga, ND, CCN 355034 Skilled nursing facility Operational/Managerial Control (100%) Jan 1, 1978
Tioga Medical Center - Powers Lake RHCPowers Lake, ND, CCN 353987 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Aug 1, 1990
Aug 1, 1990
Tioga Medical Center-Tioga RHCTioga, ND, CCN 353986 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Aug 1, 1990

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 8

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": "1140048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220918400000",
    "number": "1013981893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 159",
            "city": "TIOGA",
            "state": "ND",
            "postal_code": "588520159",
            "telephone_number": "701-664-3305",
            "fax_number": "701-664-2240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "RAY MINI MALL",
            "address_2": "RAILROAD AVE",
            "city": "RAY",
            "state": "ND",
            "postal_code": "58849",
            "telephone_number": "701-568-3624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIOGA MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-16",
        "last_updated": "2008-09-09",
        "status": "A",
        "authorized_official_last_name": "PEDERSON",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "701-664-3305"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5024",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSND",
            "identifier": "8557",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tioga Medical Center-Ray RHC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ray, ND

Sources for this page

Verify at the official NPI Registry.