NPIMap

Organization Active NPI

St. Luke'S Hospital

  • Skilled Nursing Facility
  • Crosby, ND
National Provider Identifier
1083620199
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
5011A Issued in ND
Legal business name
ST. LUKE'S HOSPITAL
Practice address
702 1St SW
Crosby, ND 58730-0010
Phone
(701) 965-6384
Fax
(701) 965-4258
NPI assigned
Jul 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Leslie O Urvand
Title
Administrator
Phone
(701) 965-6384

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 5011A ND Primary

Addresses

Primary practice location

702 1St SW
Crosby, ND 58730-0010

Mailing address

PO Box 10
Crosby, ND 58730-0010
Phone (701) 965-6384

Other identifiers 2

IdentifierTypeStateIssuer
002923OtherNDND BLUE CROSS SWINGBED
001917MedicaidND

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100929000515 ND Part A Provider - Critical Access Hospital 4486565645 Practice locations: Crosby, ND

Hospital certification: CCN 35Z325

Legal name
ST LUKES HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Jul 4, 1984 in ND
Enrollment address
702 1St St SW
Crosby, ND 58730-3329
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
St Lukes Hopital5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Diane Casteel Individual Corporate DirectorBoard Member Nov 30, 2016
Philip Johnson Individual Corporate DirectorBoard Member Nov 30, 2016
Sandra Simonson Individual Corporate DirectorBoard Member Nov 30, 2004
Art Schilke Individual Corporate DirectorBoard Member Nov 30, 1995
Jerry King Individual Corporate DirectorBoard Member Nov 30, 2017
St Lukes Hospital Organization, Crosby, ND Corporation Operational/Managerial Control May 1, 2018 100%
Mark Holm Individual Corporate DirectorBoard Member Nov 30, 2010
Loren Johnson Individual Corporate DirectorBoard Member Nov 30, 2018
Dean Throntveit Individual Corporate DirectorBoard Member Nov 30, 2012
Wanda Ely Individual Corporate DirectorBoard Member Nov 30, 2002
Jody Nelson Individual Corporate OfficerCeo Jun 1, 2018 100%
Corporate DirectorCeo Jun 1, 2018 100%
W-2 Managing EmployeeCeo Jun 1, 2018 100%
Operational/Managerial ControlCeo Jun 1, 2018 100%

Owners & managing parties with NPI records 2

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
Crosby ClinicCrosby, ND, CCN 353413 Rural health clinic 5% Or Greater Direct Ownership Interest Dec 8, 2009

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.

Practitioners & affiliated clinicians

Practitioners 5

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

Affiliated clinicians 3

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

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083620199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10",
            "city": "CROSBY",
            "state": "ND",
            "postal_code": "587300010",
            "telephone_number": "701-965-6384",
            "fax_number": "701-965-4258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 1ST SW",
            "city": "CROSBY",
            "state": "ND",
            "postal_code": "587300010",
            "telephone_number": "701-965-6384",
            "fax_number": "701-965-4258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. LUKE'S HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "URVAND",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "701-965-6384",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "ND",
            "license": "5011A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ND BLUE CROSS SWINGBED",
            "identifier": "002923",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001917",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crosby, ND

Sources for this page

Verify at the official NPI Registry.