NPIMap

Organization Active NPI

CCM Health

Doing business as CCM Health Home Care

  • Home Health Agency
  • Montevideo, MN
National Provider Identifier
1275751950
Registry record updated Jul 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
CCM HEALTH
Doing business as
CCM Health Home Care
Practice address
1409 MN-7
Montevideo, MN 56265-1715
Phone
(320) 321-8485
Fax
(320) 321-8493
NPI assigned
Apr 20, 2007
Last updated
Jul 14, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2021

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

Authorized official

Name
Brian Lovdahl
Title
Ceo
Phone
(320) 269-8877

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 333763 MN
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

1409 MN-7
Montevideo, MN 56265-1715

Mailing address

824 N 11TH St
Montevideo, MN 56265-1629
Phone (320) 269-8877

Other names 1

  • CCM Health Home Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040615001153 MN Part A Provider - Home Health Agency 4284539453 Practice locations: Clara City, MN; Montevideo, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1275751950. Details of each certification follow.

Home health agency certification: CCN 247216

Legal name
CCM HEALTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
May 8, 1986
Last certification
Oct 24, 2018
Ownership / control type
Proprietary
Organization structure
GovernmentNon-profit
Incorporated
May 8, 1986 in MN
Enrollment address
1409 MN-7
Montevideo, MN 56265-1715
HHA Branch

Other NPIs with the same Medicare PAC ID 6

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
CCM HealthCCN 247216 · All quality measures
Overall star rating
2.5 of 5
Ownership
Proprietary
Certified
May 8, 1986
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
CCM Health7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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
City of Montevideo Organization, Montevideo, MN 5% Or Greater Direct Ownership Interest Aug 1, 1955 50%
Mark W Rekow Individual Corporate OfficerBoard Member Jan 1, 2013 16%
Nathan Schmidt Individual Corporate OfficerBoard Member Jan 1, 2014 16%
Deserae Anspach Individual Corporate OfficerCfo Jun 1, 2021
Operational/Managerial ControlCfo Jun 1, 2021
Nicholas Krueger Individual Corporate DirectorCommission Member Sep 1, 2006
Lydia D Kranz Individual W-2 Managing EmployeeMedical Staff Services Manager Apr 25, 2018 5%
Candice Jaenisch Individual Corporate OfficerBoard Member Jan 1, 2021 16%
Steve Condon Individual Corporate OfficerBoard Member Jan 1, 2017 16%
Brian a Lovdahl Individual Corporate OfficerCeo Jun 1, 2018 100%
Operational/Managerial ControlCeo Jun 1, 2018 100%
David Lieser Individual Corporate OfficerBoard Mamber Jan 1, 2018 16%
Steven M Sulflow Individual Corporate OfficerBoard Member Jan 1, 2021 16%
Chippewa County Organization, Montevideo, MN Created for acquisition 5% Or Greater Direct Ownership Interest Aug 1, 1955 50%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 6

Facilities that share an organizational owner with 5% or greater ownership or operational control.

  • CCM Health

    dba Chippewa County Montevideo Hospital Swing Bed

    • Medicare Defined Swing Bed Hospital Unit
    • Montevideo, MN
    • NPI 1346460755

    Chippewa County, City of Montevideo

    CMS ownership
  • CCM Health
    • Rural Health Clinic/Center
    • Montevideo, MN
    • NPI 1407636475

    Chippewa County, City of Montevideo

    CMS ownership
  • CCM Health
    • Rural Health Clinic/Center
    • Milan, MN
    • NPI 1457132466

    Chippewa County, City of Montevideo

    CMS ownership
  • CCM Health
    • Rural Health Clinic/Center
    • Marshall, MN
    • NPI 1487436655

    Chippewa County, City of Montevideo

    CMS ownership
  • CCM Health
    • Rural Health Clinic/Center
    • Clara City, MN
    • NPI 1679354690

    Chippewa County, City of Montevideo

    CMS ownership
  • CCM Health
    • Critical Access Hospital
    • Montevideo, MN
    • NPI 1720086028

    Chippewa County, City of Montevideo

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 5

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 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": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626220800000",
    "number": "1275751950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 N 11TH ST",
            "city": "MONTEVIDEO",
            "state": "MN",
            "postal_code": "562651629",
            "telephone_number": "320-269-8877",
            "fax_number": "320-269-8186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 MN-7",
            "city": "MONTEVIDEO",
            "state": "MN",
            "postal_code": "562651715",
            "telephone_number": "320-321-8485",
            "fax_number": "320-321-8493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCM HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2021-07-14",
        "certification_date": "2021-06-22",
        "status": "A",
        "authorized_official_last_name": "LOVDAHL",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "320-269-8877"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MN",
            "license": "333763",
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CCM Health Home Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CCM Health Home Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Montevideo, MN

Sources for this page

Verify at the official NPI Registry.