Mille Lacs Health System
Organization Active NPI Community Based Hospice Care Agency · Onamia, MN
NPI 1124282272 · NPPES record last updated Mar 24, 2011
Key facts
- NPI
- 1124282272
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- License
- 337604 (MN)
- Legal business name
- MILLE LACS HEALTH SYSTEM
- Practice address
- 200 Elm St N
Onamia, MN 56359-7901 - Phone
- (888) 532-4127
- Fax
- (320) 532-4325
- NPI assigned
- Jul 17, 2008
- Organization subpart
- Yes
- Parent organization (as reported)
- MILLE LACS HEALTH SYSTEM
Authorized official
- Name
- Mr. John W Unzen
- Title
- Cfo
- Phone
- (320) 532-2581
Owners & managing parties with NPI records 12
-
Patti Jean Hook, M.D.
-
Arden Edward Virnig, M.D.
Owned or controlled facilities with NPI records 3
Other NPIs with the same Medicare PAC ID 9
Corporate family (same tax ID) 8
Facilities with the same owner 2
Practitioners 47
-
Timothy D Aadland, M.D.
-
Thomas Howard Bracken, M.D.
-
Shanon Erin Caillier, CNP
-
Jessica Anne Fligge, D.N.P. APRN-BC, CNP
-
Ryan Michael Fox, MD
-
Nash Redmond Gleason, PHYSICIAN ASSISTANT
-
Patti Jean Hook, M.D.
-
Fahad Khemani, MD
-
Nicole Loxterkamp, APRN, NP-C
-
Stephen Mariash, D.P.M.
-
Earle C Munns, DO
-
Huy Nguyen, M.D
-
Susana Njuakom, NP
-
Corey Pieper, PHD
-
Juliette Power, MD
Medicare Care Compare: Hospice
- Listed as
- Mille Lacs Health System Hospice
- Ownership
- Non-Profit
- Certified
- May 28, 2010
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
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
- Corporation · Non-profit
- Incorporated
- Jun 20, 1990 in MN
- Enrollment address
- 200 Elm St N
Onamia, MN 56359-7901
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Robert Dubbs |
Corporate Director | Jan 8, 2015 | |
| Rebecca K Fossand |
Corporate Director | Jan 4, 2016 | |
| Amy S Ninham |
W-2 Managing Employee |
Mar 10, 2025 | |
| Andrew Knutson |
Corporate Officer |
Jan 27, 2025 | |
| W-2 Managing Employee |
Jan 27, 2025 | ||
| Robert a Athman |
Corporate Director |
Jan 1, 2025 | |
| Jean M Stafford |
Corporate Director |
Jan 13, 2022 | |
| Roger W Tramm |
Corporate Director |
Jan 1, 2023 | |
| Mille Lacs Health System |
Operational/Managerial Control | Jun 17, 2009 | |
| Anthony Hass |
Corporate Director |
Jan 1, 2023 | |
| Tracy L Sam |
Corporate Director |
Jan 1, 2024 | |
| Louis P Gravel |
Corporate Director |
Jan 12, 2012 | |
| Patti J Hook |
Corporate Director | Sep 1, 1991 | |
| Arden Virnig |
W-2 Managing Employee |
Jan 1, 2001 | |
| Dennis Burr |
Corporate Director | Jan 8, 2015 |
All facility ownership & control disclosures 3
| Facility | Type | Role | Since |
|---|---|---|---|
| Cura of Onamia |
Skilled nursing facility | Adp of the SNF | Jul 22, 2002 |
| Mille Lacs Health System |
Rural health clinic | Operational/Managerial Control | Sep 10, 2008 |
| Mille Lacs Health System |
Rural health clinic | Operational/Managerial Control | Sep 9, 2008 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090819000740 | MN | Part a Provider - Hospice | 4789577834 | Practice locations: Onamia, MN |
National Provider Directory
- Tax ID family
- Mille Lacs Family Clini
- Part of
- Mille Lacs Family Clini
Interoperability endpoints
- https://fhir.yourcareuniverse.net/tenant/9372d935-a8ce-495b-bbed-e139e5c922cf
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker |
104100000X | |||
| Registered Nurse |
163W00000X | |||
| Licensed Practical Nurse |
164W00000X | |||
| Physical Therapist |
225100000X | |||
| Occupational Therapist |
225X00000X | |||
| Speech-Language Assistant |
2355S0801X | |||
| Community Based Hospice Care Agency | 251G00000X | 337604 | MN | Yes |
| Home Health Aide |
374U00000X | |||
| Homemaker |
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
- Mille Lacs Hospice
Other providers in Onamia, MN
- Mille Lacs Band of Ojibwe Indians
- Mille Lacs Band of Ojibwe Indians
- Mille Lacs Band of Ojibwe Indians
- Mille Lacs Band of Ojibwe Indians
- Mille Lacs Band of Ojibwe Public Health
- Mille Lacs Health System
- Mille Lacs Health System
- Mille Lacs Health System
- Mille Lacs Health System
- Mille Lacs Health System
All providers in Onamia, MN · Community Based Hospice Care Agency in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 24, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.