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Organization Active NPI

Towner County Medical Center Inc

  • Rural Health Clinic/Center
  • Cando, ND
National Provider Identifier
1124041389
Registry record updated Jul 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
TOWNER COUNTY MEDICAL CENTER INC
Practice address
228 1St Ave
Cando, ND 58324-7500
Phone
(701) 698-2541
NPI assigned
Jul 26, 2006
Organization subpart
Yes
Parent organization
TOWNER COUNTY MEDICAL CENTER INCAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Tammy L Larson
Title
Cfo
Phone
(701) 968-2560

Owners & managing parties with NPI records 2

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

  • Benjamin Bucher, FNP-BC
    • Family Nurse Practitioner
    • Rolla, ND
    • NPI 1114282936

    Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership
  • Anil Potti, MD
    • Hematology & Oncology Physician
    • Grand Forks, ND
    • NPI 1427122266

    Contracted Managing Employee, Operational/Managerial Control

    CMS ownership

Owned or controlled facilities with NPI records 1

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

Other NPIs with the same Medicare PAC ID 3

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

Practitioners 231

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

View all 231

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, MN3 enrollments

Rural health clinic certification: CCN 353404

Legal name
TOWNER COUNTY MEDICAL CENTER INC
Doing business as
TOWNER COUNTY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 1, 1993
Last certification
Oct 16, 2019
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jul 23, 1992 in ND
Enrollment address
228 1St Ave
Cando, ND 58324-7500

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040123000581 ND Part B Supplier - Clinic/Group Practice 6800798497 Receives reassigned benefits from 18 practitioners
Practice locations: Cando, ND
O20080617000756 ND Part A Provider - Rural Health Clinic 6800798497 Practice locations: Cando, ND
O20160111001169 MN Part B Supplier - Clinic/Group Practice 6800798497 Receives reassigned benefits from 211 practitioners
Practice locations: Roseville, MN

All disclosed owners & managing parties 11

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
Justine Puppe Individual W-2 Managing EmployeeClinic Manager Jul 2, 2017
Operational/Managerial ControlClinic Manager Jul 2, 2017
John Peters Individual Corporate Director Nov 1, 2012
Michael Farbo Individual Corporate Director Nov 1, 2010
Tammy Larson Individual Corporate OfficerCfo May 31, 2024
W-2 Managing EmployeeCfo Apr 1, 2008
Operational/Managerial ControlCfo Apr 1, 2008
Randina Bjornstad Individual Corporate Director Nov 1, 2014
Anil Potti Individual Contracted Managing EmployeeMD; Nov 1, 2013
Operational/Managerial ControlMedical Director Nov 1, 2013
Michelle Gibbens Individual Corporate Director Aug 26, 2020
Ben J Bucher Individual Corporate OfficerCeo May 31, 2024
W-2 Managing EmployeeCeo Apr 1, 2015
Operational/Managerial ControlCeo Apr 1, 2015
Thomas Belzer Individual Corporate Officer Nov 22, 2023
Corporate Director Oct 26, 2005
Gregory Westlind Individual Corporate Officer Nov 22, 2023
Corporate Director Oct 26, 2005
David Wolsky Individual Corporate Officer Nov 22, 2023
Corporate Director Jan 21, 2008

All facility ownership & control disclosures 1

Medicare enrollment files

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Towner County Medical Center IncCando, ND, CCN 35Z331 Hospital Operational/Managerial Control Sep 1, 1993

National Provider Directory

National Provider Directory
Part of
Towner Co Mem Hosp

Locations

701 11th St
Cando, ND 58324
Phone (701) 968-2600

2301 25th St S
Ste O
Fargo, ND 58103

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

NPPES NPI Registry

Primary practice location

228 1St Ave
Cando, ND 58324-7500

Mailing address

PO Box 688
Cando, ND 58324-0688
Phone (701) 968-2556

Other practice location 1

7448 Highway 281
Cando, ND 58324-9202
Phone (701) 968-2541

Other identifiers 6

NPPES NPI Registry
IdentifierTypeStateIssuer
16119MedicaidND
574105000MedicaidMN
398004OtherNDBCBS PROVIDER #
5052MedicaidND
398001OtherNDBCBS PROVIDER #
8193OtherNDBCBS PROVIDER #

Other names 1

NPPES NPI Registry
  • TOWNER COUNTY MEDICAL CENTER 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 Jul 30, 2024.

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722297600000",
    "number": "1124041389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 688",
            "city": "CANDO",
            "state": "ND",
            "postal_code": "583240688",
            "telephone_number": "701-968-2556",
            "fax_number": "701-968-2574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "228 1ST AVE",
            "city": "CANDO",
            "state": "ND",
            "postal_code": "583247500",
            "telephone_number": "701-698-2541"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7448 Highway 281",
            "address_purpose": "LOCATION",
            "city": "Cando",
            "state": "ND",
            "postal_code": "583249202",
            "country_code": "US",
            "telephone_number": "701-968-2541",
            "fax_number": "701-968-2574",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TOWNER COUNTY MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TOWNER COUNTY MEDICAL CENTER INC",
        "enumeration_date": "2006-07-26",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-22",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "701-968-2560"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "16119",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "574105000",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "398004",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5052",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "398001",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "8193",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TOWNER COUNTY MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "TOWNER COUNTY MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cando, ND

Sources for this page

Verify at the official NPI Registry.