NPIMap

Organization Active NPI

Altru Health System

Doing business as Altru Clinic - Thief River Falls

  • Rural Health Clinic/Center
  • Thief River Falls, MN
National Provider Identifier
1285074328
Registry record updated Nov 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ALTRU HEALTH SYSTEM
Doing business as
Altru Clinic - Thief River Falls
Practice address
1845 Highway 59 S Ste 800
Thief River Falls, MN 56701-4318
Phone
(218) 681-7280
NPI assigned
Jul 3, 2013
Last updated
Nov 18, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
ALTRU HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 18, 2025

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

Authorized official

Name
Derek Goebel
Title
Chief Financial Officer
Phone
(701) 780-1470

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1845 Highway 59 S Ste 800
Thief River Falls, MN 56701-4318

Mailing address

PO Box 860939
Minneapolis, MN 55486-0939
Phone (701) 780-5000

Other names 1

  • Altru Clinic - Thief River Falls Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031110000135 MN Part B Supplier - Clinic/Group Practice 1355251604 Receives reassigned benefits from 217 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hallock, MN; Warroad, MN; Warren, MN; Thief River Falls, MN; Saint Paul, MN; Roseville, MN; Roseau, MN; Red Lake Falls, MN…
O20221112000026 MN Part A Provider - Rural Health Clinic 1355251604 Practice locations: Thief River Falls, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285074328. Details of each certification follow.

Rural health clinic certification: CCN 243498

Legal name
ALTRU HEALTH SYSTEM
Doing business as
ALTRU CLINIC - THIEF RIVER FALLS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 23, 2023
Last certification
Feb 23, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1997 in ND
Enrollment address
1845 Highway 59 S
Ste 800
Thief River Falls, MN 56701-4318
Related CCNs
350019

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

Other NPIs with the same Medicare PAC ID 13

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

View all 13

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
Physicians Associates M24 organizations share this tax ID, including this one
Part of
Physicians Associates M

Other organizations with this tax ID 23

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

View all 23

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Tammy Peterson Individual Corporate Director Jan 1, 2023
Rebecca K Novacek Individual Corporate Director Sep 23, 2024
Eric Halverson Individual Corporate Director Dec 21, 2020
Russel Crary Individual Corporate Director Oct 23, 2023
Karen McLennan Individual Corporate Director Nov 23, 2020
Scott Meyer Individual Corporate Director Dec 18, 2023
Tod Forkel Individual Corporate OfficerChief Executive Officer Feb 28, 2022
Corporate DirectorChief Executive Officer Feb 28, 2022
Derek Goebel Individual Corporate OfficerChief Financial Officer Jan 15, 2023
W-2 Managing EmployeeAd; Jan 15, 2023
Andrew Sorbo Individual Corporate Director Jan 1, 2023
Erin Navarro Individual Corporate Director Jul 1, 2018
Courtney K McNamee Individual W-2 Managing EmployeeAd; Mar 11, 2024
Jody B Treuer Individual Corporate Director Sep 30, 2019
Joshua Deere Individual Corporate Director Sep 1, 2022

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Altru Rehabilitation HospitalGrand Forks, ND, CCN 353027 Hospital 5% Or Greater Direct Ownership Interest (40%) May 24, 2021
Valley Senior Living on ColumbiaGrand Forks, ND, CCN 355067 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jun 1, 1994
May 21, 2025
Woodside VillageGrand Forks, ND, CCN 355112 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jun 1, 1994
May 21, 2025
Altru's Home HealthGrand Forks, ND, CCN 357014 Home health agency 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1997

Owned or controlled facilities with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1372809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763424000000",
    "number": "1285074328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860939",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554860939",
            "telephone_number": "701-780-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1845 HIGHWAY 59 S STE 800",
            "city": "THIEF RIVER FALLS",
            "state": "MN",
            "postal_code": "567014318",
            "telephone_number": "218-681-7280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTRU HEALTH SYSTEM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALTRU HEALTH SYSTEM",
        "enumeration_date": "2013-07-03",
        "last_updated": "2025-11-18",
        "certification_date": "2025-11-18",
        "status": "A",
        "authorized_official_last_name": "GOEBEL",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "701-780-1470"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Altru Clinic - Thief River Falls",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Altru Clinic - Thief River Falls",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Thief River Falls, MN

Sources for this page

Verify at the official NPI Registry.