NPIMap

Organization Active NPI

Cooperstown Medical Center

Doing business as Cooperstown Medical Center Critical Access Hospital

  • Critical Access Hospital
  • Cooperstown, ND
National Provider Identifier
1235239229
Registry record updated Aug 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
5010P Issued in ND
Legal business name
COOPERSTOWN MEDICAL CENTER
Doing business as
Cooperstown Medical Center Critical Access Hospital
Dakota Regional Medical Center
Practice address
107 12TH St S
Cooperstown, ND 58425-4501
Phone
(701) 786-1700
Fax
(701) 786-7121
NPI assigned
Sep 22, 2006
Last updated
Aug 29, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
COOPERSTOWN MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 29, 2023

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

Authorized official

Name
Kelley Shawn
Title
Admin Assistant/Credentialing
Phone
(701) 786-1709

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 5010P ND Primary

Addresses

Primary practice location

107 12TH St S
Cooperstown, ND 58425-4501

Mailing address

107 12TH St S
Cooperstown, ND 58425-4501
Phone (701) 786-1700

Other identifiers 4

IdentifierTypeStateIssuer
489OtherNDBLUE CROSS BLUE SHIELD
87726OtherMEDICA
1009MedicaidND
01009717OtherPREFERED ONE

Other names 2

  • Cooperstown Medical Center Critical Access Hospital Doing business as
  • Dakota Regional Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060502000847 ND Part A Provider - Critical Access Hospital 5698687689 Receives reassigned benefits from 9 practitioners
Practice locations: Cooperstown, ND

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1235239229. Details of each certification follow.

Hospital certification: CCN 351306

Legal name
COOPERSTOWN MEDICAL CENTER
Doing business as
DAKOTA REGIONAL MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jul 1, 2000
Last certification
Jun 29, 2022
Beds
18
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Feb 17, 1946 in ND
Enrollment address
107 12TH St S
Cooperstown, ND 58425-4501
Main/Primary Hospital Location

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

Other NPIs with the same Medicare PAC ID 4

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Cooperstown Medical CenterCCN 351306 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Cooperstown Medical Center4 organizations share this tax ID, including this one
Part of
Cooperstown Medical Center

Other organizations with this tax ID 3

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

Locations

107 12th St S
Cooperstown, ND 58425
Phone (701) 786-1700

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Barry Getz Individual Corporate DirectorBoard President Jan 1, 2015
Gerald Stokka Individual Corporate DirectorBoard Vice President Dec 29, 2021
Benjamin Halvorson Individual Corporate Director Apr 19, 2022
James Halvorson Individual Corporate Director Dec 30, 2020
Larry Grandalen Individual Corporate Director Apr 19, 2022
Nicole Johnson Individual Corporate OfficerChief Executive Officer Feb 1, 2014
W-2 Managing EmployeeAdministrator/Ceo Feb 1, 2014
Operational/Managerial ControlAdministrator/Ceo Aug 15, 2013
Barbara Anderson Individual Corporate OfficerChief Financial Officer Aug 19, 2014
W-2 Managing EmployeeChief Financial Officer Aug 19, 2014

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Dakota Regional Medical Center Hospital SwingbedCooperstown, ND, CCN 35Z306 Hospital Operational/Managerial Control Jan 21, 2009
Dakota Regional Medical Ctr-LakotaLakota, ND, CCN 358511 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 15, 2021
Oct 15, 2021
Cooperstown Medical CenterNew Rockford, ND, CCN 358514 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 1, 2022
Aug 1, 2022

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Cooperstown Medical Center

    dba Cooperstown Medical Center Swing Bed

    • Medicare Defined Swing Bed Hospital Unit
    • Cooperstown, ND
    • NPI 1376635151

    Operational/Managerial Control

    CMS ownership
  • Cooperstown Medical Center

    dba Dakota Regional Medical Center

    • Rural Health Clinic/Center
    • Lakota, ND
    • NPI 1821760679

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Cooperstown Medical Center

    dba DRMC New Rockford RHC

    • Rural Health Clinic/Center
    • New Rockford, ND
    • NPI 1992459721

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 9

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.

Affiliated clinicians 12

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": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693267200000",
    "number": "1235239229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 12TH ST S",
            "city": "COOPERSTOWN",
            "state": "ND",
            "postal_code": "584254501",
            "telephone_number": "701-786-1700",
            "fax_number": "701-786-7121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 12TH ST S",
            "city": "COOPERSTOWN",
            "state": "ND",
            "postal_code": "584254501",
            "telephone_number": "701-786-1700",
            "fax_number": "701-786-7121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOPERSTOWN MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COOPERSTOWN MEDICAL CENTER",
        "enumeration_date": "2006-09-22",
        "last_updated": "2023-08-29",
        "certification_date": "2023-08-29",
        "status": "A",
        "authorized_official_last_name": "SHAWN",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_title_or_position": "ADMIN ASSISTANT/CREDENTIALING",
        "authorized_official_telephone_number": "701-786-1709"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "ND",
            "license": "5010P",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "489",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "87726",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1009",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERED ONE",
            "identifier": "01009717",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cooperstown Medical Center Critical Access Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dakota Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cooperstown, ND

Sources for this page

Verify at the official NPI Registry.