NPIMap

Organization Active NPI

Sawtooth Mountain Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Grand Marais, MN
National Provider Identifier
1306832894
Registry record updated Jan 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SAWTOOTH MOUNTAIN CLINIC, INC.
Practice address
513 5TH Ave W
Grand Marais, MN 55604-3017
Phone
(218) 387-2330
Fax
(218) 387-1278
NPI assigned
Sep 21, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2025

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

Authorized official

Name
Jeff Stoddard
Title
Cfo
Phone
(218) 877-8263

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 22021 MN
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

513 5TH Ave W
Grand Marais, MN 55604-3017

Mailing address

513 5TH Ave W
Grand Marais, MN 55604-3017
Phone (218) 387-2330

Other practice location 1

62 Upper Rd
Grand Portage, MN 55605-3010
Phone (218) 475-2235

Other practice location 2

9 Good Neighbor Hill Rd
Tofte, MN 55615-2802
Phone (218) 387-2330

Other identifiers 9

IdentifierTypeStateIssuer
536253900MedicaidMN
BC69144COOtherMNGROUP CLAIMS-BCBS
785090500MedicaidMN
744708600MedicaidMN
844318100MedicaidMN
241806OtherMNMEDICARE/OSCAR CERTIFICATION
873397000MedicaidMN
639097800MedicaidMN
4F029TEOtherMNDR. TERRILL-BCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20031017000011 MN Part A Provider - Federally Qualified Health Center (FQHC) 8224940010 Practice locations: Grand Marais, MN
O20041103000490 MN Part B Supplier - Clinic/Group Practice 8224940010 Receives reassigned benefits from 18 practitioners
Practice locations: Grand Marais, MN; Grand Portage, MN; Tofte, MN
O20250314000532 MN Part A Provider - Federally Qualified Health Center (FQHC) 8224940010 Practice locations: Tofte, MN
O20250314000674 MN Part A Provider - Federally Qualified Health Center (FQHC) 8224940010 Practice locations: Grand Portage, MN

Federally qualified health center certification: CCN 241806

Legal name
SAWTOOTH MOUNTAIN CLINIC INC
Organization structure
CorporationNon-profit
Incorporated
Mar 22, 1979 in MN
Enrollment address
513 5TH Ave W
Grand Marais, MN 55604-3017

Federally qualified health center certification: CCN 241004

Legal name
SAWTOOTH MOUNTAIN CLINIC INC
Doing business as
BIRCH GROVE CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 2, 2025
Last certification
Apr 2, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
9 Good Neighbor Hill Rd
Tofte, MN 55615-2802

Federally qualified health center certification: CCN 241003

Legal name
SAWTOOTH MOUNTAIN CLINIC INC
Doing business as
GRAND PORTAGE HEALTH SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 18, 2025
Last certification
Feb 18, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
62 Upper Rd
Grand Portage, MN 55605-3010

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
24D0692831Grand Portage Health Service62 Upper Rd, Grand Portage, MN 55605Certificate of waiverJun 3, 2027

National Provider Directory

National Provider Directory
Tax ID family
Birch Grove Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

9 Good Neighbor Hill Rd
Tofte, MN 55615
Phone (218) 387-2330

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Suzanne Davies Individual Corporate DirectorBoard Member Aug 26, 2019
Richard Anderson Individual Corporate DirectorBoard Vice President Jun 25, 2012
Jenny Kartes Individual Corporate DirectorBoard Treasurer Oct 22, 2012
Edwina Hertzberg Individual Corporate DirectorBoard Member Jun 25, 2007
Barbara Jean Meyers Individual Corporate DirectorBoard Member Nov 22, 2021
Katherine F Surbaugh Individual Corporate OfficerCeo Aug 1, 2019
W-2 Managing EmployeeCeo Aug 1, 2019
Corporate OfficerPresident/Ceo Aug 1, 2019
W-2 Managing Employee Aug 1, 2019
Valerie Ulstad Individual Corporate DirectorBoard Member Jul 22, 2019
Diane Pearson Individual Corporate DirectorBoard Secretary Jun 26, 2016
Jessa Frost Individual Corporate DirectorBoard Member Apr 27, 2020
Corporate OfficerBoard Member Apr 27, 2020
Jeff Stoddard Individual Corporate OfficerCfo Jun 30, 2019
W-2 Managing EmployeeCfo Jun 30, 2019
Operational/Managerial ControlCfo Jun 30, 2019
W-2 Managing Employee Jun 30, 2019
Kylan Hill Individual Corporate DirectorBoard Member Oct 25, 2021
Corporate DirectorBoard Treasurer Oct 25, 2021
Mary Harrelson Individual Corporate DirectorBoard Member Jan 28, 2019
Corporate OfficerBoard Member Jan 28, 2019
Matthew Brown Individual Corporate DirectorBoard Member Jun 27, 2011
Corporate OfficerBoard Member Jun 27, 2011
Erin Watson Individual Corporate OfficerCoo May 5, 2015
W-2 Managing EmployeeCoo May 15, 2015
Ruth Olson Individual Corporate DirectorBoard Member Oct 22, 2018
Ellen Seltz Individual W-2 Managing EmployeeAdministrative Specialist Feb 7, 2022
Clare Shirley Individual Corporate DirectorBoard President Nov 28, 2016

Practitioners & affiliated clinicians

Practitioners 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1127260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735862400000",
    "number": "1306832894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "513 5TH AVE W",
            "city": "GRAND MARAIS",
            "state": "MN",
            "postal_code": "556043017",
            "telephone_number": "218-387-2330",
            "fax_number": "218-387-1278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "513 5TH AVE W",
            "city": "GRAND MARAIS",
            "state": "MN",
            "postal_code": "556043017",
            "telephone_number": "218-387-2330",
            "fax_number": "218-387-1278"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "62 Upper Rd",
            "address_purpose": "LOCATION",
            "city": "Grand Portage",
            "state": "MN",
            "postal_code": "556053010",
            "country_code": "US",
            "telephone_number": "218-475-2235",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9 Good Neighbor Hill Rd",
            "address_purpose": "LOCATION",
            "city": "Tofte",
            "state": "MN",
            "postal_code": "556152802",
            "country_code": "US",
            "telephone_number": "218-387-2330",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SAWTOOTH MOUNTAIN CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-21",
        "last_updated": "2025-01-03",
        "certification_date": "2025-01-03",
        "status": "A",
        "authorized_official_last_name": "STODDARD",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "218-877-8263"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "22021",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "536253900",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP CLAIMS-BCBS",
            "identifier": "BC69144CO",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "785090500",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "744708600",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "844318100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE/OSCAR CERTIFICATION",
            "identifier": "241806",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "873397000",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "639097800",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR. TERRILL-BCBS",
            "identifier": "4F029TE",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Marais, MN

Sources for this page

Verify at the official NPI Registry.