NPIMap

Organization Active NPI

St. Andrew's Hospital

Doing business as St. Andrew's Bottineau Clinic

  • Rural Health Clinic/Center
  • Bottineau, ND
National Provider Identifier
1295497097
Registry record updated Oct 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ST. ANDREW'S HOSPITAL
Doing business as
St. Andrew's Bottineau Clinic
Practice address
314 Ohmer St
Bottineau, ND 58318-1059
Phone
(701) 228-9400
NPI assigned
Oct 8, 2021
Last updated
Oct 8, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2021

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

Authorized official

Name
Brenda Arneson
Title
Human Resource Director
Phone
(701) 228-9314

Specialties & licenses 1

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

Addresses

Primary practice location

314 Ohmer St
Bottineau, ND 58318-1059

Mailing address

314 Ohmer St
Bottineau, ND 58318-1059
Phone (701) 228-9400

Other names 1

  • St. Andrew's Bottineau Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210202002562 ND Part A Provider - Rural Health Clinic 4880505999 1 other NPI on this enrollment
Practice locations: Bottineau, ND

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295497097. Details of each certification follow.

Rural health clinic certification: CCN 358508

Legal name
ST ANDREWS HOSPITAL
Doing business as
SMP HEALTH - ST. ANDREW'S
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 19, 2017
Last certification
Feb 13, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Mar 29, 1945 in ND
Enrollment address
314 Ohmer St
Bottineau, ND 58318-1059
Related CCNs
351307

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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
St Andrews Hospital N5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Melissa Block Individual Corporate DirectorBoard Member Jul 1, 2015 100%
Darin Bohl Individual Corporate DirectorBoard Member Jul 1, 2017 100%
Daniel Bullinger Individual Corporate DirectorBoard Member Jan 1, 2017 100%
St Andrews Hospital Organization, Bottineau, ND Non-profit 5% Or Greater Direct Ownership Interest Nov 30, 2020 100%
Dorothy C Bunce Individual Corporate DirectorBoard Member Jul 1, 2009 100%
Christopher Albertson Individual Corporate OfficerCeo/President Oct 1, 2020 100%
Operational/Managerial ControlCeo/President Oct 1, 2020 100%

Owners & managing parties with NPI records 3

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

Owned or controlled facilities with NPI records 1

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

Change-of-ownership history 1

DateEventCounterparty
Nov 30, 2020 Change of OwnershipThis provider was the buyer St. Andrew's Bottineau Clinic, LLCCCN 353851, ND, NPI 1902803802

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 32

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 32

NPI Registry JSON

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

{
    "created_epoch": "1633651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633651200000",
    "number": "1295497097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 OHMER ST",
            "city": "BOTTINEAU",
            "state": "ND",
            "postal_code": "583181059",
            "telephone_number": "701-228-9400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 OHMER ST",
            "city": "BOTTINEAU",
            "state": "ND",
            "postal_code": "583181059",
            "telephone_number": "701-228-9400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. ANDREW'S HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-08",
        "last_updated": "2021-10-08",
        "certification_date": "2021-10-08",
        "status": "A",
        "authorized_official_last_name": "ARNESON",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "HUMAN RESOURCE DIRECTOR",
        "authorized_official_telephone_number": "701-228-9314"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Andrew's Bottineau Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bottineau, ND

Sources for this page

Verify at the official NPI Registry.