NPIMap

Organization Active NPI

Mille Lacs Health System

Doing business as Mille Lacs Hospice

  • Community Based Hospice Care Agency
  • Onamia, MN
National Provider Identifier
1124282272
Registry record updated Mar 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
337604 Issued in MN
Legal business name
MILLE LACS HEALTH SYSTEM
Doing business as
Mille Lacs Hospice
Practice address
200 Elm St N
Onamia, MN 56359-7901
Phone
(888) 532-4127
Fax
(320) 532-4325
NPI assigned
Jul 17, 2008
Last updated
Mar 24, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
MILLE LACS HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 24, 2011

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

Authorized official

Name
Mr. John W Unzen
Title
Cfo
Phone
(320) 532-2581

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X
Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163W00000X
Licensed Practical NurseGroup: 193200000X MULTI-SPECIALTY GROUP 164W00000X
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Speech-Language AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 2355S0801X
Community Based Hospice Care Agency 251G00000X 337604 MN Primary
Home Health AideGroup: 193200000X MULTI-SPECIALTY GROUP 374U00000X
HomemakerGroup: 193200000X MULTI-SPECIALTY GROUP 376J00000X

Addresses

Primary practice location

200 Elm St N
Onamia, MN 56359-7901

Mailing address

200 Elm St N
PO Box a
Onamia, MN 56359-7901
Phone (320) 532-3154

Other names 1

  • Mille Lacs Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090819000740 MN Part A Provider - Hospice 4789577834 Practice locations: Onamia, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124282272. Details of each certification follow.

Hospice certification: CCN 241588

Legal name
MILLE LACS HEALTH SYSTEM
Certification status
Active
Provider type (POS)
Hospice
Participating since
May 28, 2010
Last certification
Oct 14, 2021
Ownership / control type
Other
Organization structure
CorporationNon-profit
Incorporated
Jun 20, 1990 in MN
Enrollment address
200 Elm St N
Onamia, MN 56359-7901

Other NPIs with the same Medicare PAC ID 9

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Mille Lacs Health System HospiceCCN 241588 · All quality measures
Ownership
Non-Profit
Certified
May 28, 2010
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Mille Lacs Hospital10 organizations share this tax ID, including this one
Part of
Mille Lacs Hospital

Other organizations with this tax ID 9

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

Interoperability endpoints

  • FHIR API: https://fhir.yourcareuniverse.net/tenant/9372d935-a8ce-495b-bbed-e139e5c922cf

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Robert Dubbs Individual Corporate Director Jan 8, 2015
Rebecca K Fossand Individual Corporate Director Jan 4, 2016
Amy S Ninham Individual W-2 Managing EmployeeCfo Mar 10, 2025
Andrew Knutson Individual Corporate OfficerCeo Jan 27, 2025
W-2 Managing EmployeeCeo Jan 27, 2025
Robert a Athman Individual Corporate DirectorBoard Member Jan 1, 2025
Jean M Stafford Individual Corporate DirectorBoard Member Jan 13, 2022
Roger W Tramm Individual Corporate DirectorBoard Member Jan 1, 2023
Mille Lacs Health System Organization, Onamia, MN Operational/Managerial Control Jun 17, 2009
Anthony Hass Individual Corporate DirectorBoard Member Jan 1, 2023
Tracy L Sam Individual Corporate DirectorBoard Member Jan 1, 2024
Louis P Gravel Individual Corporate DirectorBoard Member Jan 12, 2012
Patti J Hook Individual Corporate Director Sep 1, 1991
Arden Virnig Individual W-2 Managing EmployeeMD Jan 1, 2001
Dennis Burr Individual Corporate Director Jan 8, 2015

Owners & managing parties with NPI records 12

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Cura of OnamiaOnamia, MN, CCN 245127 Skilled nursing facility Adp of the SNF Jul 22, 2002
Mille Lacs Health SystemIsle, MN, CCN 243975 Rural health clinic Operational/Managerial Control Sep 10, 2008
Mille Lacs Health SystemOnamia, MN, CCN 243976 Rural health clinic Operational/Managerial Control Sep 9, 2008

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 2

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

NPI Registry JSON

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

{
    "created_epoch": "1216252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300924800000",
    "number": "1124282272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 ELM ST N",
            "address_2": "PO BOX A",
            "city": "ONAMIA",
            "state": "MN",
            "postal_code": "563597901",
            "telephone_number": "320-532-3154",
            "fax_number": "320-532-3111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 ELM ST N",
            "city": "ONAMIA",
            "state": "MN",
            "postal_code": "563597901",
            "telephone_number": "888-532-4127",
            "fax_number": "320-532-4325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLE LACS HEALTH SYSTEM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MILLE LACS HEALTH SYSTEM",
        "enumeration_date": "2008-07-17",
        "last_updated": "2011-03-24",
        "status": "A",
        "authorized_official_last_name": "UNZEN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "320-532-2581",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Licensed Practical Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2355S0801X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MN",
            "license": "337604",
            "primary": true
        },
        {
            "code": "374U00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Home Health Aide",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "376J00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Homemaker",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mille Lacs Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Onamia, MN

Sources for this page

Verify at the official NPI Registry.