NPIMap

Organization Active NPI

First Care Medical Services

Doing business as Essentia Health Oklee Clinic

  • Rural Health Clinic/Center
  • Oklee, MN
National Provider Identifier
1174812465
Registry record updated Oct 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FIRST CARE MEDICAL SERVICES
Doing business as
Essentia Health Oklee Clinic
Practice address
400 Governor Street
Oklee, MN 56742-0000
Phone
(218) 796-4525
NPI assigned
Apr 7, 2011
Last updated
Oct 1, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2021

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

Authorized official

Name
Kim Bodensteiner
Title
Cfo
Phone
(218) 435-7633

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Rural Health Clinic/Center 261QR1300X MN Primary

Addresses

Primary practice location

400 Governor Street
Oklee, MN 56742-0000

Mailing address

400 Governor Street
Oklee, MN 56742-0000
Phone (218) 796-4525

Other names 1

  • Essentia Health Oklee Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040927000035 MN Part B Supplier - Clinic/Group Practice 3678542842 Receives reassigned benefits from 106 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bagley, MN; Fosston, MN; Oklee, MN
O20110628000622 MN Part A Provider - Rural Health Clinic 3678542842 Practice locations: Oklee, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174812465. Details of each certification follow.

Rural health clinic certification: CCN 243464

Legal name
FIRST CARE MEDICAL SERVICES
Doing business as
ESSENTIA HEALTH OKLEE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 25, 2012
Last certification
Jun 1, 2012
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
May 26, 1947 in MN
Enrollment address
400 Governor St
Oklee, MN 56742-4209
Related CCNs
241357

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

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Stefanie Gefroh Ellison Individual Corporate OfficerPresident Aug 12, 2024
Tim D Heilman Individual Corporate DirectorBoard Member Jan 1, 2020
Aarick L Jackson Individual Corporate DirectorBoard Member Jan 1, 2020
James M Christensen Individual Corporate DirectorBoard Member Jan 1, 2020
Taylor Grant Mertz Individual Corporate DirectorBoard Member May 17, 2022
Michael Watters Individual Corporate OfficerSecretary May 18, 2023
Alan J Hurley Individual Corporate OfficerCoo May 18, 2023
W-2 Managing EmployeeCoo May 18, 2023
Beverly Mary Horn Individual Corporate DirectorBoard Member Jan 1, 2017
Benjamin Cody Smith Individual Corporate DirectorBoard Member May 17, 2022
Douglas J Arvin Individual Corporate OfficerVP of Finance / Cfo May 18, 2023
W-2 Managing EmployeeVP of Finance / Cfo May 18, 2023
Joel Ross Haugen Individual Corporate DirectorBoard Member Jan 1, 2017
Laurie Ann Lewandowski Individual Corporate DirectorBoard Member Jan 1, 2017
Innovis Health LLC Organization, Fargo, ND LLC, Non-profit Operational/Managerial Control Jan 1, 2017

Owners & managing parties with NPI records 11

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

Facilities with the same owner 23

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

View all 23

Practitioners & affiliated clinicians

Practitioners 28

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.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1302134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633046400000",
    "number": "1174812465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 GOVERNOR STREET",
            "city": "OKLEE",
            "state": "MN",
            "postal_code": "567420000",
            "telephone_number": "218-796-4525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 GOVERNOR STREET",
            "city": "OKLEE",
            "state": "MN",
            "postal_code": "567420000",
            "telephone_number": "218-796-4525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST CARE MEDICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-07",
        "last_updated": "2021-10-01",
        "certification_date": "2021-10-01",
        "status": "A",
        "authorized_official_last_name": "BODENSTEINER",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "218-435-7633"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Oklee Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Essentia Health Oklee Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oklee, MN

Sources for this page

Verify at the official NPI Registry.