NPIMap

Organization Active NPI

Madonna Towers of Rochester, Inc

Doing business as Madonna Towers of Rochester

  • Skilled Nursing Facility
  • Rochester, MN
National Provider Identifier
1104821891
Registry record updated May 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
328643 Issued in MN
Legal business name
MADONNA TOWERS OF ROCHESTER, INC
Doing business as
Madonna Towers of Rochester
Practice address
4001 19TH Ave NW
Rochester, MN 55901-4505
Phone
(507) 288-3911
Fax
(507) 288-0393
NPI assigned
Jun 17, 2005
Last updated
May 26, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
BENEDICTINE HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 26, 2022

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

Authorized official

Name
Tricia L Bergien
Title
Director, Reimbursement
Phone
(612) 991-6519

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 328643 MN Primary

Addresses

Primary practice location

4001 19TH Ave NW
Rochester, MN 55901-4505

Mailing address

4001 19TH Ave NW
Rochester, MN 55901-4505
Phone (507) 288-3911

Other names 1

  • Madonna Towers of Rochester Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040419001246 MN Part A Provider - Skilled Nursing Facility 6305831231 Practice locations: Rochester, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104821891. Details of each certification follow.

Skilled nursing facility certification: CCN 245153A

Legal name
MADONNA TOWERS OF ROCHESTER, INC
Doing business as
MADONNA TOWERS OF ROCHESTER
Organization structure
CorporationNon-profit
Incorporated
May 8, 1995 in MN
Enrollment address
4001 19TH Ave NW
Rochester, MN 55901-4505
Nursing home name
MADONNA TOWERS OF ROCHESTER
Affiliated entity
BENEDICTINE HEALTH SYSTEM

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D0955792Madonna Towers of Rochester Inc4001 19TH Avenue Northwest, Rochester, MN 55901Certificate of waiverJan 10, 2027
24D1065128Madonna Towers4001 19TH Ave NW, Rochester, MN 55901Certificate of waiverFeb 21, 2027

National Provider Directory

National Provider Directory

Locations

4001 19th Ave NW
Rochester, MN 55901
Phone (507) 288-3911

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Barbara Trueman Individual Corporate DirectorBoard Member Sep 1, 2018
Barbara Graham Individual Corporate DirectorBoard Member Aug 31, 2018
Bruce Snyder Individual Corporate DirectorBoard Member Sep 1, 2014
Kevin J Rymanowski Individual Corporate OfficerTreasurer/Cfo Jan 1, 2008
Diane Eustice Individual Corporate DirectorBoard Member Sep 1, 2014
Tricia Bergien Individual Corporate OfficerAssistant Treasurer Jan 1, 2017
Justin R Anderson Individual Corporate DirectorBoard Member/Chairperson Sep 1, 2012
Christine K Boldt Individual Corporate DirectorEx-Officio Sep 1, 2005
Michael Obrien Individual Corporate DirectorBoard Member Nov 1, 2012
James Russell Individual Corporate DirectorBoard Member Feb 18, 2016
Gerald Carley Individual Operational/Managerial ControlCeo/President Jan 3, 2018
Larry Koshire Individual Corporate DirectorVice Chairperson, Board Member May 21, 2015
Timothy Geisler Individual Corporate DirectorBoard Member Jan 1, 2013
Michael Willard Individual Corporate DirectorBoard Member Sep 1, 2014
Christine Marie Bakke Individual Contracted Managing EmployeeAdministrator/Ceo Apr 17, 2017
Diane J Schwinghammer Individual Corporate DirectorBoard Member Sep 1, 2013
Benedictine Health System Organization, Cambridge, MN Corporation, Management services company, Non-profit 5% Or Greater Direct Ownership Interest May 25, 1995 100%
Operational/Managerial Control May 25, 1995 100%

Facilities with the same owner 27

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

View all 27

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1118966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653523200000",
    "number": "1104821891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4001 19TH AVE NW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559014505",
            "telephone_number": "507-288-3911",
            "fax_number": "507-288-0393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 19TH AVE NW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559014505",
            "telephone_number": "507-288-3911",
            "fax_number": "507-288-0393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADONNA TOWERS OF ROCHESTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BENEDICTINE HEALTH SYSTEM",
        "enumeration_date": "2005-06-17",
        "last_updated": "2022-05-26",
        "certification_date": "2022-05-26",
        "status": "A",
        "authorized_official_last_name": "BERGIEN",
        "authorized_official_first_name": "TRICIA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DIRECTOR, REIMBURSEMENT",
        "authorized_official_telephone_number": "612-991-6519"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": "328643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Madonna Towers of Rochester",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Madonna Towers of Rochester",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rochester, MN

Sources for this page

Verify at the official NPI Registry.