First Care Medical Services
Organization Active NPI Rural Health Clinic/Center · Oklee, MN
NPI 1174812465 · NPPES record last updated Oct 1, 2021
Key facts
- NPI
- 1174812465
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- FIRST CARE MEDICAL SERVICES
- Practice address
- 400 Governor Street
Oklee, MN 56742-0000 - Phone
- (218) 796-4525
- NPI assigned
- Apr 7, 2011
- Organization subpart
- No
Authorized official
- Name
- Kim Bodensteiner
- Title
- Cfo
- Phone
- (218) 435-7633
Owners & managing parties with NPI records 11
-
Benjamin C Smith, MD
Other NPIs on the same Medicare enrollment 3
Other NPIs with the same Medicare PAC ID 5
Related certifications (CCN) 1
Facilities with the same owner 23
Practitioners 46
-
Susan Bauer, D.O.
-
David A Brett, D.O.
-
Daniele R Krouse, PA-C, LAT, ATC
-
Judy A Bellanger-Dahl, PA-C
-
Bryan Mikael Johnson, PA-C
-
Mei Wen W Sather, NP-C
-
Sheila K Teiken, APRN,CNP
-
Miriam Elaine Tell, NURSE PRACTITIONER
-
Michele Thieman, MD
-
Shelley Wahlin-Quinlan, PA-C
-
Cheryl White, MD
-
Parul Gupta, M.D.
-
Nicholas O'Neill, D.O.
-
Ryan Ahlgren, NP
-
Nina Marie Bradfield, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
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
- Corporation · Non-profit
- Incorporated
- May 26, 1947 in MN
- Enrollment address
- 400 Governor St
Oklee, MN 56742-4209 - Related CCNs
- 241357
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Stefanie Gefroh Ellison |
Corporate Officer |
Aug 12, 2024 | |
| Tim D Heilman |
Corporate Director |
Jan 1, 2020 | |
| Aarick L Jackson |
Corporate Director |
Jan 1, 2020 | |
| James M Christensen |
Corporate Director |
Jan 1, 2020 | |
| Taylor Grant Mertz |
Corporate Director |
May 17, 2022 | |
| Michael Watters |
Corporate Officer |
May 18, 2023 | |
| Alan J Hurley |
Corporate Officer |
May 18, 2023 | |
| W-2 Managing Employee |
May 18, 2023 | ||
| Beverly Mary Horn |
Corporate Director |
Jan 1, 2017 | |
| Benjamin Cody Smith |
Corporate Director |
May 17, 2022 | |
| Douglas J Arvin |
Corporate Officer |
May 18, 2023 | |
| W-2 Managing Employee |
May 18, 2023 | ||
| Joel Ross Haugen |
Corporate Director |
Jan 1, 2017 | |
| Laurie Ann Lewandowski |
Corporate Director |
Jan 1, 2017 | |
| Innovis Health LLC |
Operational/Managerial Control | Jan 1, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Locations
400 Governor St
Oklee, MN 56742
Phone (218) 796-4525
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | MN | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 381347900 | Medicaid | MN |
Other names
- Essentia Health Oklee Clinic
Other providers in Oklee, MN
- Cornerstone Residence of Oklee LLC
- Freedom Living Center, LLC
- Ind School Dist 627
- Independent School District 2906 Red Lake County Central
- Inter-County Community Council
- Oklee Economic Development
All providers in Oklee, MN · Rural Health Clinic/Center in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 1, 2021. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.