NPIMap

Organization Active NPI

Community Memorial Hospital Association

  • Medicare Defined Swing Bed Hospital Unit
  • Cloquet, MN
National Provider Identifier
1255496188
Registry record updated Sep 4, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
331457 Issued in MN
Legal business name
COMMUNITY MEMORIAL HOSPITAL ASSOCIATION
Practice address
512 Skyline Blvd
Cloquet, MN 55720-3787
Phone
(218) 879-4641
Fax
(218) 879-3237
NPI assigned
Dec 22, 2006
Last updated
Sep 4, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2007

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

Authorized official

Name
Mr. Richard L. Breuer
Title
Ceo
Phone
(218) 878-7621

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 331457 MN Primary

Addresses

Primary practice location

512 Skyline Blvd
Cloquet, MN 55720-3787

Mailing address

512 Skyline Blvd
Cloquet, MN 55720-3787
Phone (218) 879-4641

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120327000669 MN Part A Provider - Critical Access Hospital 0042129991 Practice locations: Cloquet, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255496188. Details of each certification follow.

Hospital certification: CCN 24Z364

Legal name
COMMUNITY MEMORIAL HOSPITAL ASSOCIATION
Doing business as
COMMUNITY MEMORIAL HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1960 in MN
Enrollment address
512 Skyline Blvd
Cloquet, MN 55720-3787
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
Community Memorial Hosp2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Lee R Olsen Individual Corporate DirectorBoard Member Dec 14, 2015
Stephen J Risacher Individual Corporate DirectorBoard Member Sep 19, 2021
David E Hall Individual Corporate DirectorBoard Member Jan 1, 2005
Jennifer L Dupuis Individual Corporate DirectorBoard Member Sep 19, 2022
Joanna M Robnik Individual Corporate DirectorBoard Member Sep 19, 2019
Kirk D Johnson Individual Corporate OfficerCfo Jan 1, 2024
W-2 Managing EmployeeCfo Jan 1, 2024
Brad K Anderson Individual Corporate DirectorCfo Dec 3, 2001 100%
W-2 Managing EmployeeCfo Dec 3, 2001 100%
Kara L Underwood Individual Corporate DirectorBoard Member Dec 19, 2016
Richard L Breuer Individual Corporate DirectorCeo Sep 1, 1999 100%
W-2 Managing EmployeeCeo Sep 1, 1999 100%
Leslie E Riess Individual Corporate DirectorBoard Member Sep 19, 2021
Nancy Klassen Individual Corporate DirectorBoard Member Sep 19, 2020
Kirk M Wimmer Individual Corporate DirectorBoard Member Sep 19, 2019

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Affiliated clinicians 6

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": "1166745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188864000000",
    "number": "1255496188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 SKYLINE BLVD",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557203787",
            "telephone_number": "218-879-4641",
            "fax_number": "218-879-3237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 SKYLINE BLVD",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557203787",
            "telephone_number": "218-879-4641",
            "fax_number": "218-879-3237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEMORIAL HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-22",
        "last_updated": "2007-09-04",
        "status": "A",
        "authorized_official_last_name": "BREUER",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "218-878-7621",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "MN",
            "license": "331457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cloquet, MN

Sources for this page

Verify at the official NPI Registry.