NPIMap

Organization Active NPI

Jacobson Memorial Hospital Care Center

  • Rural Health Clinic/Center
  • Richardton, ND
National Provider Identifier
1043649486
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
215 3Rd Ave W
Richardton, ND 58652-7109
Phone
(701) 974-3372
Fax
(701) 584-2397
NPI assigned
Nov 6, 2013
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 ND Primary

Addresses

Primary practice location

215 3Rd Ave W
Richardton, ND 58652-7109

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
1478719MedicaidND

Other names 1

  • Richardton Clinic Doing business as

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
O20190513002701 ND Part A Provider - Rural Health Clinic 2466363981 Practice locations: Richardton, ND

Rural health clinic certification: CCN 353460

Legal name
JACOBSON MEMORIAL HOSPITAL CARE CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 1, 2019
Last certification
Mar 4, 2020
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1949 in ND
Enrollment address
215 3Rd Ave W
Richardton, ND 58652-7109
Related CCNs
351314

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

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Jacobson Memorial Hospital3 organizations share this tax ID, including this one
Part of
Jacobson Memorial Hospital

Other organizations with this tax ID 2

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

8885 Highway 10
Richardton, ND 58652
Phone (701) 974-3304

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
Joann Schatz Individual Corporate Director Feb 9, 2023
Leona Zemliska Individual Corporate OfficerVice Chair Feb 9, 2023
Dennis Sabin Individual Corporate DirectorBoard Member Nov 20, 2018
Operational/Managerial ControlBoard Member Nov 20, 2018
Jacobson Memorial Hospital Care Center Organization, Elgin, ND Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2019 100%
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 Officer Feb 4, 2025
Corporate Director Feb 4, 2025
Kristin Heid Individual Corporate OfficerCoo Jun 15, 2023
Operational/Managerial ControlCoo Jun 15, 2023
Ann Hertz Individual Corporate DirectorBoard Member Nov 20, 2014
Operational/Managerial ControlBoard Member Nov 20, 2014
Ronald Bartz Individual Corporate DirectorBoard Member Nov 20, 2013
Operational/Managerial ControlBoard Member Nov 20, 2013
Patrick Diehl Individual Corporate DirectorBoard Member Nov 20, 2018
Operational/Managerial ControlBoard Member Nov 20, 2018

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 1

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

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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

Change-of-ownership history 2

DateEventCounterparty
Jul 1, 2019 Change of OwnershipThis provider was the buyer Richardton Clinic - Richardton Health CenterCCN 353899, ND, NPI 1043649486
Jul 1, 2019 Change of OwnershipThis provider was the seller Jacobson Memorial Hospital Care CenterCCN 353460, ND, NPI 1043649486

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1383696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769385600000",
    "number": "1043649486",
    "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": "215 3RD AVE W",
            "city": "RICHARDTON",
            "state": "ND",
            "postal_code": "586527109",
            "telephone_number": "701-974-3372",
            "fax_number": "701-584-2397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACOBSON MEMORIAL HOSPITAL CARE CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JACOBSON MEMORIAL HOSPITAL CARE CENTER",
        "enumeration_date": "2013-11-06",
        "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": "ND",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1478719",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Richardton Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Richardton Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Richardton, ND

Sources for this page

Verify at the official NPI Registry.