NPIMap

Organization Active NPI

Mille Lacs Health System

Doing business as Mille Lacs Family Clinic Onamia

  • Rural Health Clinic/Center
  • Onamia, MN
National Provider Identifier
1275796773
Registry record updated Apr 26, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MILLE LACS HEALTH SYSTEM
Doing business as
Mille Lacs Family Clinic Onamia
Practice address
200 Elm St N
Onamia, MN 56359-7901
Phone
(320) 532-3154
Fax
(320) 532-3111
NPI assigned
Jul 3, 2008
Last updated
Apr 26, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
MILLE LACS HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 26, 2017

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

Authorized official

Name
Mr. John W Unzen
Title
Cfo
Phone
(320) 532-2581

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Medical Physician Assistant 363AM0700X
Psychologist 103T00000X
Chiropractor 111N00000X
Registered Dietitian 133V00000X
Diabetes Educator Registered Nurse 163WD0400X
Family Medicine Physician 207Q00000X
Otolaryngology Physician 207Y00000X
Psychiatry Physician 2084P0800X
Surgery Physician 208600000X

Addresses

Primary practice location

200 Elm St N
Onamia, MN 56359-7901

Mailing address

200 Elm St N
PO Box a
Onamia, MN 56359-7901
Phone (320) 532-3154

Other identifiers 6

IdentifierTypeStateIssuer
33523MIOtherMNBLUE CROSS BLUE SHIELD MINNESOTA
666353200MedicaidMN
5012782OtherMNMEDICA
10719OtherMNHEALTH PARTNERS
103185OtherMNUCARE
1006091OtherMNPREFERRED ONE

Other names 1

  • Mille Lacs Family Clinic Onamia Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040204000052 MN Part B Supplier - Clinic/Group Practice 4789577834 Receives reassigned benefits from 133 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Milaca, MN; Princeton, MN; Onamia, MN; Isle, MN; Hillman, MN; Garrison, MN
O20090224000680 MN Part A Provider - Rural Health Clinic 4789577834 Practice locations: Onamia, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1275796773. Details of each certification follow.

Rural health clinic certification: CCN 243976

Legal name
MILLE LACS HEALTH SYSTEM
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 1, 1990
Last certification
May 28, 2014
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jun 20, 1990 in MN
Enrollment address
200 Elm N St
Onamia, MN 56359-7901
Related CCNs
241356

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

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 9

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D0651646Mille Lacs Family Clinic - Onamia200 North Elm Street, Onamia, MN 56359Certificate of waiverSep 11, 2027

National Provider Directory

National Provider Directory
Part of
Mille Lacs Family Clini

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Robert Dubbs Individual Corporate DirectorBoard Member Jan 1, 2017
Rebecca K Fossand Individual W-2 Managing Employee Jan 4, 2016
Amy S Ninham Individual W-2 Managing EmployeeCfo Mar 10, 2025
Andrew Knutson Individual W-2 Managing EmployeeCeo Jan 27, 2025
Robert a Athman Individual Corporate DirectorBoard Member Jan 1, 2025
Jean M Stafford Individual Corporate Director Jan 13, 2022
Roger W Tramm Individual Corporate DirectorBoard Member Jan 1, 2023
Mille Lacs Health System Organization, Onamia, MN Operational/Managerial Control Sep 9, 2008
Anthony Hass Individual Corporate DirectorBpard Member Jan 1, 2023
Tracy L Sam Individual Corporate DirectorBoard Member Jan 1, 2024
Louis P Gravel Individual Corporate Director Jan 12, 2012
Patti J Hook Individual Corporate Director Sep 1, 1991
Arden Virnig Individual Corporate Director Sep 10, 2008
Dennis Burr Individual Corporate DirectorBoard Member Jan 1, 2017

Owners & managing parties with NPI records 12

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Cura of OnamiaOnamia, MN, CCN 245127 Skilled nursing facility Adp of the SNF Jul 22, 2002
Mille Lacs Health SystemOnamia, MN, CCN 241588 Hospice Operational/Managerial Control Jun 17, 2009
Mille Lacs Health SystemIsle, MN, CCN 243975 Rural health clinic Operational/Managerial Control Sep 10, 2008

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1215043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493164800000",
    "number": "1275796773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 ELM ST N",
            "address_2": "PO BOX A",
            "city": "ONAMIA",
            "state": "MN",
            "postal_code": "563597901",
            "telephone_number": "320-532-3154",
            "fax_number": "320-532-3111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 ELM ST N",
            "city": "ONAMIA",
            "state": "MN",
            "postal_code": "563597901",
            "telephone_number": "320-532-3154",
            "fax_number": "320-532-3111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLE LACS HEALTH SYSTEM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MILLE LACS HEALTH SYSTEM",
        "enumeration_date": "2008-07-03",
        "last_updated": "2017-04-26",
        "status": "A",
        "authorized_official_last_name": "UNZEN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "320-532-2581",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WD0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MINNESOTA",
            "identifier": "33523MI",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "666353200",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "5012782",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "10719",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "103185",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1006091",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mille Lacs Family Clinic Onamia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Onamia, MN

Sources for this page

Verify at the official NPI Registry.