Tioga Medical Center
Organization Active NPI Critical Access Hospital · Tioga, ND
NPI 1043280696 · NPPES record last updated Nov 22, 2016
Key facts
- NPI
- 1043280696
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- License
- 5048P (ND)
- Legal business name
- TIOGA MEDICAL CENTER
- Practice address
- 810 N Welo St
Tioga, ND 58852-7157 - Phone
- (701) 664-3305
- Fax
- (701) 664-2240
- NPI assigned
- Jan 25, 2006
- Organization subpart
- No
Authorized official
- Name
- Randall K Pederson
- Title
- President/Ceo
- Phone
- (701) 664-3305
Owned or controlled facilities with NPI records 4
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 7
Related certifications (CCN) 4
Practitioners 18
-
Teri Andersen, LPCC
-
Kari Ely, FNP-C
-
Jeffrey Alden Moberg Jr., PA-C
-
Amber Nelson, FNP-BC
-
Mark G Peterson, MD
-
David Petrosian, DO
-
Andrew C McCoy, MD
-
Robert H Rotering, M.D.
-
Ronald Lee Burinsky, D.O.
-
Matthew Frederick Feller, MD PA
-
Mark Allen Graves, FNP-BC
-
Benjamin J Krogh, D.O.
-
Misty Donnelly, PT
-
Andrea Keever, MOTR/L
Affiliated clinicians 45
-
Timothy J Bopp, MD
-
Lisa N Brandt, ACNP-BC
-
Kari Ely, FNP-C
-
Michael Grant, M.D.
-
Alexie Harms, PA-C
-
Brittany Haugtvedt, FNP
-
Brenna L Hudson, PA-C
-
Moayed Ibrahim, MD
-
Matthew Khouri, MD
-
Rodhan Khthir, MD
-
Brent Knudson, D.O
-
James Allen Miller, M.D.
-
Amy Mingle, MD
-
Jeffrey Alden Moberg Jr., PA-C
Medicare Care Compare: Hospital
- Listed as
- Tioga Medical Center
- Type
- Critical Access Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
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
- Corporation · Non-profit
- Incorporated
- Nov 9, 1953 in ND
- Enrollment address
- 810N Welo St
Tioga, ND 58852-7157
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Seth Wisthoff |
Corporate Director |
Mar 18, 2019 | |
| James W Booth |
Corporate Director |
Mar 20, 2013 | |
| Wendy Lenzen |
Corporate Director |
Mar 1, 2022 | |
| Patrick Joyce |
Corporate Director |
Mar 20, 2023 | |
| Kristopher Kuehn |
Corporate Director |
Mar 20, 2023 | |
| Jeremy Becker |
Corporate Director | Apr 1, 2019 | |
| Lee a Olson |
Corporate Director |
Mar 20, 2017 | |
| Jamie Eraas |
Corporate Officer |
Jan 27, 2023 | 100% |
| W-2 Managing Employee |
Nov 1, 2021 | ||
| Nathan Germundson |
Corporate Director | Apr 1, 2020 | |
| Brodie Odegaard |
Corporate Director |
Mar 20, 2017 |
All facility ownership & control disclosures 4
| Facility | Type | Role | Since |
|---|---|---|---|
| Tioga Medical Center LTC |
Skilled nursing facility | Operational/Managerial Control (100%) | Jan 1, 1978 |
| Tioga Medical Center - Powers Lake RHC |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Aug 1, 1990 Aug 1, 1990 |
| Tioga Medical Center-Ray RHC |
Rural health clinic | Operational/Managerial Control (100%) | Apr 15, 1992 |
| Tioga Medical Center-Tioga RHC |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Aug 1, 1990 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050701000482 | ND | Part a Provider - Critical Access Hospital | 1254390305 |
Receives reassigned benefits from 9 practitioners Practice locations: Tioga, ND |
National Provider Directory
- Tax ID family
- Tioga Med Ctr Clinic
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Access Hospital | 282NC0060X | 5048P | ND | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1054 | Medicaid | ND | |
| 418197 | Medicaid | MT | |
| 000869 | Other | ND | BCBSND |
Other names
- Tioga Medical Center Hospital
Other providers in Tioga, ND
- Kimberly Allyn Schaible
- Stewart Chiropractic Center PC
- Lorena Kay Stout
- Tioga Drug Inc
- Tioga Fire Department
- Tioga Medical Center
- Tioga Medical Center
- Tioga Medical Center
- Tioga Medical Center
- Tioga Medical Center Hospital
All providers in Tioga, ND · Critical Access Hospital in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 22, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.