NPIMap

Organization Active NPI

Northern Itasca Hospital District

  • Medicare Defined Swing Bed Hospital Unit
  • Bigfork, MN
National Provider Identifier
1194769265
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
331040 Issued in MN
Legal business name
NORTHERN ITASCA HOSPITAL DISTRICT
Practice address
258 Pine Tree Drive
Bigfork, MN 56628
Phone
(218) 743-3177
Fax
(218) 743-3559
NPI assigned
Jun 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Harold Daniel Odegaard
Title
Ceo
Phone
(218) 743-3177

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 331040 MN Primary

Addresses

Primary practice location

258 Pine Tree Drive
Bigfork, MN 56628

Mailing address

258 Pine Tree Drive
P.O. Box 258
Bigfork, MN 56628
Phone (218) 743-3177

Other identifiers 7

IdentifierTypeStateIssuer
2257OtherMNHEALTH PARTNERS
1010473OtherMNPREFERRED ONE
300410OtherMNUCARE
361259OtherMNHOSPICE
98592OtherMNARAZ
1547HNOOtherMNBLUE CROSS
5025357OtherMNMEDICA CHOICE

Other names 1

  • Bigfork Valley Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080208000411 MN Part A Provider - Critical Access Hospital 3274442173 Practice locations: Bigfork, MN

Hospital certification: CCN 24Z316

Legal name
NORTHERN ITASCA HOSPITAL DISTRICT
Doing business as
BIGFORK VALLEY HOSPITAL
Organization structure
OtherNon-profit
Enrollment address
258 Pine Tree Dr
Bigfork, MN 56628
Hospital Swing-Bed Unit

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

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Northern Itasca Hospital District7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Gregory Anselmo Individual Corporate DirectorBoard of Director Jan 1, 2025
Darla a Anderson Individual Corporate OfficerCfo Nov 2, 2020
W-2 Managing EmployeeCfo Nov 2, 2020
Heidi Watson Individual Corporate DirectorBoard of Director Jan 1, 2015
Daniel Heinecke Individual Corporate DirectorBoard of Director Jan 1, 2025
Gregory Cook Individual Corporate DirectorBoard of Director Sep 2, 2014
Larry Salmela Individual Corporate DirectorBoard of Director Jan 3, 2017
Carol a Gilbertson Individual Corporate DirectorBoard of Director Jan 1, 2023
Northern Itasca Hospital District Organization, Bigfork, MN 5% Or Greater Direct Ownership Interest Jan 1, 1975 100%
Clinton Cook Individual Corporate DirectorBoard of Director Jan 1, 2021
Tom Lamont Individual Corporate DirectorBoard of Director Sep 3, 2019
Teresa Kittridge Individual Corporate DirectorBoard of Director May 5, 2020
Nathan Jon Hough Individual Corporate OfficerChief Executive Officer Apr 1, 2024
W-2 Managing EmployeeChief Executive Officer Apr 1, 2024
Kurt F Fredrickson Individual Corporate DirectorBoard of Director Nov 28, 2023
Amanda Niemala Individual W-2 Managing EmployeeDirector of Revenue Cycle Jan 2, 2008
Sally Sedgwick Individual Corporate Director Oct 3, 2023
Dan Sursely Individual Corporate DirectorBoard of Director Jan 1, 2019
Gordon Rahier Individual Corporate DirectorBoard of Director Jan 1, 2021

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Bigfork Valley HospitalBigfork, MN, CCN 241316 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1975
Bigfork Valley CommunitiesBigfork, MN, CCN 245529 Skilled nursing facility Operational/Managerial Control Jan 1, 1975

Owned or controlled facilities with NPI records 2

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.

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194769265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "258 PINE TREE DRIVE",
            "address_2": "P.O. BOX 258",
            "city": "BIGFORK",
            "state": "MN",
            "postal_code": "56628",
            "telephone_number": "218-743-3177",
            "fax_number": "218-743-3559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "258 PINE TREE DRIVE",
            "city": "BIGFORK",
            "state": "MN",
            "postal_code": "56628",
            "telephone_number": "218-743-3177",
            "fax_number": "218-743-3559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN ITASCA HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ODEGAARD",
        "authorized_official_first_name": "HAROLD",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "218-743-3177",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "MN",
            "license": "331040",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "2257",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1010473",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "300410",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOSPICE",
            "identifier": "361259",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARAZ",
            "identifier": "98592",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "1547HNO",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA CHOICE",
            "identifier": "5025357",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bigfork Valley Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bigfork, MN

Sources for this page

Verify at the official NPI Registry.