Lac Qui Parle Clinic of Madison Inc

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

LAC QUI PARLE CLINIC OF MADISON INC

Practice address

820 3Rd Ave
Madison, MN 56256-1014

Phone

(320) 598-7551

Fax

(320) 598-7553

NPI assigned

Jun 20, 2006

Last updated

May 16, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Carol M Borgerson

Title

Cfo

Phone

(320) 698-7152

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MN, WV, FL, AZ, OH, SC, NC, NV, ND, UT, WA, CA, KY, TX, PA, MI, TN, AL, CO, IL, GA, ME, MO24 enrollments

Enrollment records 24

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144266156. Details of each certification follow.

• CCN 243990 Rural health clinic · Active · Details

Rural health clinic certification: CCN 243990

Legal name

LAC QUI PARLE CLINIC OF MADISON INC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Feb 6, 1995

Last certification

Jun 20, 2014

Ownership / control type

2B

Organization structure

CorporationNon-profit

Incorporated

Jul 15, 1992 in MN

Enrollment address

900 2ND Ave
Madison, MN 56256-1006

Related CCNs

241372

Related certifications (CCN) 1

Facilities connected through Provider of Services related, parent or unit certification numbers.

• Madison Healthcare Services

  • Critical Access Hospital
  • Madison, MN
  • NPI 1942246848

  Parent provider

  Provider of Services

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

CLIA laboratory certificates

Tax ID family

Madison Hospital2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Madison Healthcare Services

  • Skilled Nursing Facility
  • Madison, MN
  • NPI 1306832795
  NPD tax ID

Locations

All disclosed owners & managing parties 9

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

Owners & managing parties with NPI records 1

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

• Brandon Lee Ulstad, DDS

  • Dentist
  • Madison, MN
  • NPI 1376587907

  Corporate Director

  CMS ownership

Practitioners 245

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.

• Amber Boyens, RD

  • Registered Dietitian
  • Madison, MN
  • NPI 1447637889
  Medicare reassignment Care Compare group NPD
• Janice D Briones, F.N.P

  • Family Nurse Practitioner
  • Montevideo, MN
  • NPI 1386804532
  Medicare reassignment Care Compare group NPD
• Nicholas Grant Cain, CNP

  • Family Nurse Practitioner
  • Benson, MN
  • NPI 1588326128
  Medicare reassignment Care Compare group NPD
• David Allan Freeman, M.D.

  • Family Medicine Physician
  • Staples, MN
  • NPI 1871583211
  Medicare reassignment Care Compare group NPD
• Brant Nicholas Hacker, M.D.

  • Family Medicine Physician
  • Madison, MN
  • NPI 1679633655
  Medicare reassignment Care Compare group NPD
• Paul E Hodge, FNP-C

  • Family Nurse Practitioner
  • Madison, MN
  • NPI 1215308077
  Medicare reassignment Care Compare group NPD
• Lisa Marie Kuechenmeister, LPCC

  • Mental Health Counselor
  • Dawson, MN
  • NPI 1851864789
  Medicare reassignment Care Compare group NPD
• Anna Christance Lewis, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Dawson, MN
  • NPI 1124795596
  Medicare reassignment Care Compare group NPD
• Melanie Miller

  • Family Nurse Practitioner
  • Madison, MN
  • NPI 1225548738
  Medicare reassignment Care Compare group NPD
• Maria Nolte, M.D.

  • Family Medicine Physician
  • Madison, MN
  • NPI 1134462765
  Medicare reassignment Care Compare group NPD
• Heather Leann Bowen, FNP-C

  • Nurse Practitioner
  • Gainesville, TX
  • NPI 1851982334

  MN

  Medicare reassignment Care Compare group NPD
• Krystal Enger, PA-C

  • Physician Assistant
  • Detroit Lakes, MN
  • NPI 1558791145
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715817600000",
    "number": "1144266156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 2ND AVE",
            "city": "MADISON",
            "state": "MN",
            "postal_code": "562561006",
            "telephone_number": "320-598-7551",
            "fax_number": "320-598-7553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 3RD AVE",
            "city": "MADISON",
            "state": "MN",
            "postal_code": "562561014",
            "telephone_number": "320-598-7551",
            "fax_number": "320-598-7553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAC QUI PARLE CLINIC OF MADISON INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-16",
        "status": "A",
        "authorized_official_last_name": "BORGERSON",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "320-698-7152",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "3F739LA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "106646",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "933813600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wayne Hennen, RPT
• Nancy Hinrichsen
• Paul E Hodge, FNP-C
• Laura Pons Hong, M.D.
• Jenna Karels, CNP
• Lac Qui Parle County Family Service Center
• Adam Timothy Longman
• Madison Chiropractic Center
• Madison Chiropractic Center PC
• Madison Dental Clinic PLLC

• Rural Health Clinic/Center in Madison, MN
• Providers in Madison, MN by specialty
• Rural Health Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.