NPIMap

Organization Active NPI

CHI Health Connect at Home-Fargo

Doing business as CHI Health at Home - Breckenridge

  • Health Service Clinic/Center
  • Breckenridge, MN
National Provider Identifier
1215511167
Registry record updated Jan 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
CHI HEALTH CONNECT AT HOME-FARGO
Doing business as
CHI Health at Home - Breckenridge
Practice address
1110 Highway 75 N Ste a
Breckenridge, MN 56520-1108
Phone
(218) 643-2275
NPI assigned
May 7, 2021
Last updated
Jan 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2024

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

Authorized official

Name
Nicole Peyerl
Title
Director Operations/Auth Official
Phone
(701) 238-3206

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X NU Primary

Addresses

Primary practice location

1110 Highway 75 N Ste a
Breckenridge, MN 56520-1108

Mailing address

4265 45TH St S Ste 200
Fargo, ND 58104-4309
Phone (888) 538-0069

Other names 1

  • CHI Health at Home - Breckenridge Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220629003570 MN Part B Supplier - Clinic/Group Practice 4789870924 Receives reassigned benefits from 2 practitioners
Practice locations: Breckenridge, MN

Other NPIs with the same Medicare PAC ID 11

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

National Provider Directory

National Provider Directory
Tax ID family
CHI Health Connect at Home18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Locations

131 8th St S
Ste 1
Albany, MN 56307
Phone (320) 845-2440

161 4th St
Ste B
Albany, MN 56307
Phone (320) 840-0020

1110 Highway 75 N
Ste A
Breckenridge, MN 56520
Phone (218) 643-2275

1212 E Main Ave
Ste 1
Bismarck, ND 58501
Phone (701) 530-4500

1310 E Main Ave
Bismarck, ND 58501
Phone (701) 530-7191

331 3rd St N
Carrington, ND 58421
Phone (701) 652-2273

420 4th Ave NE
Devils Lake, ND 58301
Phone (701) 237-1533

986 2nd Ave W
Dickinson, ND 58601
Phone (701) 456-4378

4265 45th St S
Ste 200
Fargo, ND 58104
Phone (218) 230-0194

4816 Amber Valley Pkwy S
Fargo, ND 58104
Phone (701) 237-8139

4816 Amber Valley Pkwy S
Ste 105
Fargo, ND 58104
Phone (701) 237-8135

115 2nd Ave W
#50
Williston, ND 58801
Phone (701) 774-7430

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1620345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705881600000",
    "number": "1215511167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4265 45TH ST S STE 200",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581044309",
            "telephone_number": "888-538-0069",
            "fax_number": "701-237-8199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 HIGHWAY 75 N STE A",
            "city": "BRECKENRIDGE",
            "state": "MN",
            "postal_code": "565201108",
            "telephone_number": "218-643-2275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHI HEALTH CONNECT AT HOME-FARGO",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-07",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A",
        "authorized_official_last_name": "PEYERL",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "DIRECTOR OPERATIONS/AUTH OFFICIAL",
        "authorized_official_telephone_number": "701-238-3206"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHI Health at Home - Breckenridge",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CHI Health at Home - Breckenridge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Breckenridge, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.