NPIMap

Organization Active NPI

Glacial Ridge Hospital District

Doing business as Brooten Medical Center

  • Family Medicine Physician
  • Brooten, MN
National Provider Identifier
1255348223
Registry record updated Jul 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GLACIAL RIDGE HOSPITAL DISTRICT
Doing business as
Brooten Medical Center
Practice address
111 Pleasant Avenue
Brooten, MN 56316
Phone
(320) 346-2272
Fax
(320) 346-2273
NPI assigned
Aug 2, 2006
Last updated
Jul 18, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2012

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

Authorized official

Name
Kirk Stensrud
Title
Ceo
Phone
(320) 634-2208

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

111 Pleasant Avenue
Brooten, MN 56316

Mailing address

111 Pleasant Avenue
P.O. Box 69
Brooten, MN 56316
Phone (320) 346-2272

Other names 1

  • BROOTEN MEDICAL CENTER Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050719000315 MN Part B Supplier - Clinic/Group Practice 5294789194 Receives reassigned benefits from 125 practitioners
4 other NPIs on this enrollment
Practice locations: Starbuck, MN; Glenwood, MN; Brooten, MN
O20110324001015 MN Part A Provider - Rural Health Clinic 5294789194 Practice locations: Brooten, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255348223. Details of each certification follow.

Rural health clinic certification: CCN 243456

Legal name
GLACIAL RIDGE HOSPITAL DISTRICT
Doing business as
BROOTEN MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 10, 2012
Last certification
May 17, 2019
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1990 in MN
Enrollment address
111 Pleasant Ave N
Brooten, MN 56316-4715
Related CCNs
241376

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

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

Locations

111 Pleasant Ave N
Brooten, MN 56316
Phone (320) 346-2272

111 Pleasant Ave N
#69
Brooten, MN 56316

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Kirk a Stensrud Individual Corporate Director Mar 4, 2011
Kyle Chase Individual Corporate Director Apr 1, 2011
W-2 Managing Employee Apr 1, 2011

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Glacial Ridge HomecareGlenwood, MN, CCN 247212 Home health agency 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Mar 19, 2010
Mar 19, 2010
Glacial Ridge HospiceGlenwood, MN, CCN 241502 Hospice 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Mar 4, 1993
Aug 1, 2000

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 126

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 126

NPI Registry JSON

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342569600000",
    "number": "1255348223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 PLEASANT AVENUE",
            "address_2": "P.O. BOX 69",
            "city": "BROOTEN",
            "state": "MN",
            "postal_code": "56316",
            "telephone_number": "320-346-2272",
            "fax_number": "320-346-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 PLEASANT AVENUE",
            "city": "BROOTEN",
            "state": "MN",
            "postal_code": "56316",
            "telephone_number": "320-346-2272",
            "fax_number": "320-346-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLACIAL RIDGE HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-02",
        "last_updated": "2012-07-18",
        "status": "A",
        "authorized_official_last_name": "STENSRUD",
        "authorized_official_first_name": "KIRK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "320-634-2208"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BROOTEN MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brooten, MN

Sources for this page

Verify at the official NPI Registry.