NPIMap

Organization Active NPI

Culbertson Froid Bainville Healthcare Corporation

Doing business as Roosevelt Medical Clinic

  • Rural Health Clinic/Center
  • Culbertson, MT
National Provider Identifier
1114037744
Registry record updated Jan 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
273977 Issued in MT
Legal business name
CULBERTSON FROID BAINVILLE HEALTHCARE CORPORATION
Doing business as
Roosevelt Medical Clinic
Practice address
818 2ND Ave East
Culbertson, MT 59218-0110
Phone
(406) 787-6400
Fax
(406) 787-6473
NPI assigned
Aug 30, 2006
Last updated
Jan 9, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
CULBERTSON FROID BAINVILLE HEALTH CARE CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 9, 2025

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

Authorized official

Name
Mr. Jamason Schmidt
Title
Chief Executive Officer
Phone
(406) 787-6407

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 273977 MT Primary

Addresses

Primary practice location

818 2ND Ave East
Culbertson, MT 59218-0110

Mailing address

PO Box 110
Culbertson, MT 59218-0110
Phone (406) 787-6400

Other identifiers 4

IdentifierTypeStateIssuer
MSF0058618OtherMTMONTANA STATE FUND
0000063122OtherMTBLUE CROSS BLUE SHIELD
DB4867OtherMTRAILROAD MEDICARE
0720083MedicaidMT

Other names 1

  • Roosevelt Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060306000376 MT Part A Provider - Rural Health Clinic 3173425436 Practice locations: Culbertson, MT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114037744. Details of each certification follow.

Rural health clinic certification: CCN 273977

Legal name
CULBERTSON FROID BAINVILLE HEALTH CARE CORPORATION
Doing business as
ROOSEVELT MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 1, 1992
Last certification
Aug 5, 2025
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
818 2ND Ave E
Culbertson, MT 59218-9363
Related CCNs
271308

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
Roosevelt Mem HSP HSG2 organizations share this tax ID, including this one
Part of
Roosevelt Mem HSP HSG

Other organizations with this tax ID 1

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

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Steven Larsen Individual Corporate DirectorBoard Member May 1, 2022 16%
Kathleen Thompson Individual Corporate DirectorBoard Member May 1, 2020 16%
Audrey Stromberg Individual Corporate OfficerChief Executive Officer Feb 1, 2000 100%
Operational/Managerial ControlChief Executive Officer Feb 1, 2000 100%
Amber Fox Individual Corporate DirectorBoard Member Jun 1, 2021 16%
Sharon Schmitz Individual Corporate DirectorBoard Member May 1, 2015 16%
Paula Schledewitz Individual Corporate DirectorBoard Member Jun 1, 2003 16%
Jamason Schmidt Individual Corporate OfficerChief Executive Officer Aug 12, 2024
Cassandra Bergum Individual Corporate DirectorBoard Member May 1, 2022 16%

Practitioners & affiliated clinicians

Practitioners 7

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": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736380800000",
    "number": "1114037744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 110",
            "city": "CULBERTSON",
            "state": "MT",
            "postal_code": "592180110",
            "telephone_number": "406-787-6400",
            "fax_number": "406-787-6473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "818 2ND AVE EAST",
            "city": "CULBERTSON",
            "state": "MT",
            "postal_code": "592180110",
            "telephone_number": "406-787-6400",
            "fax_number": "406-787-6473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CULBERTSON FROID BAINVILLE HEALTHCARE CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CULBERTSON FROID BAINVILLE HEALTH CARE CORPORATION",
        "enumeration_date": "2006-08-30",
        "last_updated": "2025-01-09",
        "certification_date": "2025-01-09",
        "status": "A",
        "authorized_official_last_name": "SCHMIDT",
        "authorized_official_first_name": "JAMASON",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "406-787-6407",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MT",
            "license": "273977",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MONTANA STATE FUND",
            "identifier": "MSF0058618",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0000063122",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DB4867",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0720083",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Roosevelt Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Culbertson, MT

Sources for this page

Verify at the official NPI Registry.