NPIMap

Organization Active NPI

P R Health Corporation

Doing business as First Care RHC

  • Rural Health Clinic/Center
  • Park River, ND
National Provider Identifier
1306850706
Registry record updated Nov 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
P R HEALTH CORPORATION
Doing business as
First Care RHC
Practice address
115 Vivian St.
Park River, ND 58270-4540
Phone
(701) 284-7555
Fax
(701) 284-4605
NPI assigned
Jul 28, 2006
Last updated
Nov 27, 2007By the provider in NPPES
Organization subpart
Yes
Parent organization
P R HEALTH CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 27, 2007

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

Authorized official

Name
Ms. Louise Dryburgh
Title
Ceo
Phone
(701) 284-7500

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

115 Vivian St.
Park River, ND 58270-4540

Mailing address

PO Box I
115 Vivian St.
Park River, ND 58270-0708
Phone (701) 284-7555

Other identifiers 1

IdentifierTypeStateIssuer
D05074MedicaidND

Other names 1

  • First Care RHC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040426000229 ND Part B Supplier - Clinic/Group Practice 0840102760 Receives reassigned benefits from 12 practitioners
Practice locations: Park River, ND
O20060503000838 ND Part A Provider - Rural Health Clinic 0840102760 Practice locations: Park River, ND

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306850706. Details of each certification follow.

Rural health clinic certification: CCN 353405

Legal name
P R HEALTH CORPORATION
Doing business as
FIRST CARE RHC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 14, 1993
Last certification
Feb 24, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Aug 29, 1950 in ND
Enrollment address
115 Vivian St W
Park River, ND 58270-4540
Related CCNs
351326

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

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Part of
St Ansgars RHC

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Katherine Hall Individual Corporate Director Jan 1, 2019
P R Health Corporation Organization, Park River, ND 5% Or Greater Direct Ownership Interest Jan 1, 2001
Eugene Bossert Individual Corporate Director Apr 1, 2017
Brenda Nilson Individual Corporate Director Apr 1, 2022
Gale Beneda Individual Corporate Director Apr 1, 2017
Nina Hollingsworth Individual W-2 Managing EmployeeCfo Sep 15, 2022
Cindy Staven Individual W-2 Managing Employee Jun 1, 2016
Loretta Monson Individual Corporate Director Apr 1, 2014
Nicolas D Beneda Individual Corporate Director Jan 1, 2019
Marcus Lewis Individual Corporate Officer Dec 4, 2017
Corporate DirectorCeo Dec 4, 2017
W-2 Managing EmployeeCeo Dec 4, 2017
Michael Helt Individual Corporate Director Jan 1, 2018
Patty Dahlen Individual Corporate Director Jan 1, 2018
Mark K Helgeson Individual Corporate Director Apr 1, 2015
Kirk Ham Individual Corporate Director Apr 1, 2022
Dennis Markusen Individual Corporate Director Apr 1, 2015

Owners & managing parties with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 61

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 61

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196121600000",
    "number": "1306850706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX I",
            "address_2": "115 VIVIAN ST.",
            "city": "PARK RIVER",
            "state": "ND",
            "postal_code": "582700708",
            "telephone_number": "701-284-7555",
            "fax_number": "701-284-4605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 VIVIAN ST.",
            "city": "PARK RIVER",
            "state": "ND",
            "postal_code": "582704540",
            "telephone_number": "701-284-7555",
            "fax_number": "701-284-4605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "P R HEALTH CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "P R HEALTH CORPORATION",
        "enumeration_date": "2006-07-28",
        "last_updated": "2007-11-27",
        "status": "A",
        "authorized_official_last_name": "DRYBURGH",
        "authorized_official_first_name": "LOUISE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "701-284-7500",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D05074",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "First Care RHC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Park River, ND

Sources for this page

Verify at the official NPI Registry.