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Organization Active NPI

CHI Health Connect at Home-Fargo

  • Home Health Agency
  • Valley City, ND
National Provider Identifier
1265747737
Registry record updated Jan 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
4031 Issued in ND
Legal business name
CHI HEALTH CONNECT AT HOME-FARGO
Practice address
367 2ND St NW
Valley City, ND 58072-2971
Phone
(701) 845-6550
Fax
(701) 845-6552
NPI assigned
Aug 9, 2010
Organization subpart
Yes
Parent organization
COMMONSPIRIT HEALTHAs reported in NPPES

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
Home Health Agency 251E00000X 4031 ND Primary

Addresses

Primary practice location

367 2ND St NW
Valley City, ND 58072-2971

Mailing address

4265 45TH St S Ste 200
Fargo, ND 58104-4309
Phone (701) 237-8116

Other identifiers 1

IdentifierTypeStateIssuer
4031MedicaidND

Other names 1

  • CHI Health at Home Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110107000373 ND Part A Provider - Home Health Agency 4789870924 Practice locations: Valley City, ND

Home health agency certification: CCN 357035

Legal name
CHI HEALTH CONNECT AT HOME - FARGO
Doing business as
CHI HEALTH AT HOME
Certification status
Active
Provider type (POS)
Home health agency
Participating since
May 29, 1985
Last certification
Oct 30, 2019
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Incorporated
Feb 10, 2010 in MN
Enrollment address
367 2ND St NW
Valley City, ND 58072-2971

Other NPIs with the same Medicare PAC ID 11

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
CHI Health at Home - HHACCN 357035
Overall star rating
3.5 of 5
Ownership
Non-Profit
Certified
May 29, 1985
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

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

Other organizations with this tax ID 17

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

View all 17

Locations

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

367 2nd St NW
Valley City, ND 58072
Phone (701) 845-6550

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Commonspirit Health Organization, Englewood, CO Corporation, Non-profit 5% Or Greater Direct Ownership Interest Feb 1, 2019
Wendy L McGinley Individual Corporate DirectorBoard Member Jul 1, 2019
Nicole a Peyerl Individual Corporate OfficerMarket Vice President of Operations Oct 1, 2021
W-2 Managing EmployeeAd; Oct 1, 2021
Gretchen K Dobervich Individual Corporate DirectorBoard Member Jan 1, 2018
Mary Quandt Individual Corporate DirectorBoard Member Jan 1, 2025
Caroline Stoltz Individual Corporate DirectorBoard Member Jan 1, 2025
Lance W Gulleson Individual Corporate DirectorBoard Member Jul 1, 2018
Gloria a Dohman Individual Corporate DirectorBoard Member Jul 1, 2017

Practitioners & affiliated clinicians

Practitioners 2

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

Affiliated clinicians 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1281312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705881600000",
    "number": "1265747737",
    "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": "701-237-8116",
            "fax_number": "701-237-8188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "367 2ND ST NW",
            "city": "VALLEY CITY",
            "state": "ND",
            "postal_code": "580722971",
            "telephone_number": "701-845-6550",
            "fax_number": "701-845-6552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHI HEALTH CONNECT AT HOME-FARGO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMONSPIRIT HEALTH",
        "enumeration_date": "2010-08-09",
        "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": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "ND",
            "license": "4031",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4031",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHI Health at Home",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CHI Health at Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Valley City, ND

Sources for this page

Verify at the official NPI Registry.