NPIMap

Organization Active NPI

Tioga Medical Center

Doing business as Tioga Medical Center Hospital

  • Critical Access Hospital
  • Tioga, ND
National Provider Identifier
1043280696
Registry record updated Nov 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
5048P Issued in ND
Legal business name
TIOGA MEDICAL CENTER
Doing business as
Tioga Medical Center Hospital
Practice address
810 N Welo St
Tioga, ND 58852-7157
Phone
(701) 664-3305
Fax
(701) 664-2240
NPI assigned
Jan 25, 2006
Last updated
Nov 22, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2016

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
Critical Access Hospital 282NC0060X 5048P ND Primary

Addresses

Primary practice location

810 N Welo St
Tioga, ND 58852-7157

Mailing address

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

Other names 1

  • Tioga Medical Center Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050701000482 ND Part A Provider - Critical Access Hospital 1254390305 Receives reassigned benefits from 9 practitioners
Practice locations: Tioga, ND

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043280696. Details of each certification follow.

Hospital certification: CCN 351300

Legal name
TIOGA MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jul 1, 1999
Last certification
Apr 6, 2022
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Nov 9, 1953 in ND
Enrollment address
810N Welo St
Tioga, ND 58852-7157

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).

Care Compare: Hospital

Medicare Care Compare
Listed as
Tioga Medical CenterCCN 351300 · 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
Tax ID family
Tioga Comm Hospital8 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 10

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

NameRoleSinceShare
Seth Wisthoff Individual Corporate DirectorDirector Mar 18, 2019
James W Booth Individual Corporate DirectorDirector Mar 20, 2013
Wendy Lenzen Individual Corporate DirectorDirector Mar 1, 2022
Patrick Joyce Individual Corporate DirectorDirector Mar 20, 2023
Kristopher Kuehn Individual Corporate DirectorDirector Mar 20, 2023
Jeremy Becker Individual Corporate Director Apr 1, 2019
Lee a Olson Individual Corporate DirectorDirector Mar 20, 2017
Jamie Eraas Individual Corporate OfficerChief Executive Officer Jan 27, 2023 100%
W-2 Managing EmployeePresident/Ceo Nov 1, 2021
Nathan Germundson Individual Corporate Director Apr 1, 2020
Brodie Odegaard Individual Corporate DirectorVice-Chairman Mar 20, 2017

All facility ownership & control disclosures 4

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-Ray RHCRay, ND, CCN 353988 Rural health clinic Operational/Managerial Control (100%) Apr 15, 1992
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 4

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

Practitioners & affiliated clinicians

Practitioners 18

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 18

Affiliated clinicians 45

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

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479772800000",
    "number": "1043280696",
    "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": "810 N WELO ST",
            "city": "TIOGA",
            "state": "ND",
            "postal_code": "588527157",
            "telephone_number": "701-664-3305",
            "fax_number": "701-664-2240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIOGA MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-25",
        "last_updated": "2016-11-22",
        "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": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "ND",
            "license": "5048P",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tioga Medical Center Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tioga, ND

Sources for this page

Verify at the official NPI Registry.