NPIMap

Organization Active NPI

CHI Health Connect at Home-Fargo

  • Home Health Agency
  • Williston, ND
National Provider Identifier
1083928048
Registry record updated Jan 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
CHI HEALTH CONNECT AT HOME-FARGO
Practice address
1301 15TH Ave W
Williston, ND 58801-3821
Phone
(701) 774-7430
Fax
(701) 774-7465
NPI assigned
Aug 2, 2010
Organization subpart
Yes
Parent organization
COMMONSPIRIT HEALTHAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Nicole Peyerl
Title
Director Operations/Auth Official
Phone
(701) 238-3206

Other NPIs with the same Medicare PAC ID 11

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

Corporate family (same tax ID) 17

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

View all 17

Practitioners 2

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

Affiliated clinicians 10

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
CHI Health at Home - HHACCN 357030
Overall star rating
3 of 5
Ownership
Non-Profit
Certified
Oct 18, 1984
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Medicare participation

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

Home health agency certification: CCN 357030

Medicare enrollment files
Legal name
CHI HEALTH CONNECT AT HOME - FARGO
Doing business as
CHI HEALTH AT HOME
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Oct 18, 1984
Last certification
Aug 14, 2019
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Incorporated
Feb 10, 2010 in MN
Enrollment address
1301 15TH W Ave
Williston, ND 58801-3821

All disclosed owners & managing parties 8

Medicare enrollment files

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

NameRoleSinceShare
Commonspirit Health Organization, Englewood, CO Chain home office 5% Or Greater Direct Ownership Interest Feb 26, 1986 100%
Wendy L McGinley Individual Corporate DirectorBoard Member Jul 1, 2019
Nicole a Peyerl Individual Corporate OfficerMarketing Vice President Operations Oct 1, 2021
W-2 Managing EmployeeMarket Vice President Operations Oct 1, 2021
Gretchen K Dobervich Individual Corporate DirectorBoard Member Jan 1, 2018
Mary Quandt Individual Corporate DirectorBoard Member Jul 1, 2025
Caroline Stoltz Individual Corporate DirectorBoard Member Jul 1, 2025
Lance W Gulleson Individual Corporate DirectorBoard Member Jul 1, 2018
Gloria a Dohman Individual Corporate DirectorBoard Member Jul 1, 2017

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20101130000589 ND Part a Provider - Home Health Agency 4789870924 Practice locations: Williston, ND

National Provider Directory

National Provider Directory
Tax ID family
CHI Health Connect at Home (18 organizations share this tax ID)
Part of
Catholic Health Initiatives

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 4033A ND
Home Health Agency 251E00000X ND Primary

Addresses

NPPES NPI Registry

Primary practice location

1301 15TH Ave W
Williston, ND 58801-3821

Mailing address

4265 45TH St S Ste 200
Fargo, ND 58104-4309
Phone (701) 237-8116

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
4033MedicaidND

Other names 1

NPPES NPI Registry
  • CHI Health at Home Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 22, 2024.

{
    "created_epoch": "1280707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705881600000",
    "number": "1083928048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4265 45TH ST S STE 200",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581044309",
            "telephone_number": "701-237-8116",
            "fax_number": "701-237-8188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 15TH AVE W",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588013821",
            "telephone_number": "701-774-7430",
            "fax_number": "701-774-7465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHI HEALTH CONNECT AT HOME-FARGO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMONSPIRIT HEALTH",
        "enumeration_date": "2010-08-02",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A",
        "authorized_official_last_name": "PEYERL",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "DIRECTOR OPERATIONS/AUTH OFFICIAL",
        "authorized_official_telephone_number": "701-238-3206"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "ND",
            "license": "4033A",
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "ND",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4033",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHI Health at Home",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CHI Health at Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Williston, ND

Sources for this page

Verify at the official NPI Registry.