NPIMap

Organization Active NPI

Mille Lacs Health System

Doing business as Mille Lacs Family Health Center

  • Rural Health Clinic/Center
  • Hillman, MN
National Provider Identifier
1326200411
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 Health Center
Practice address
26362 370TH Ave
Hillman, MN 56338-2349
Phone
(320) 277-3682
Fax
(320) 277-3372
NPI assigned
Jun 30, 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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X

Addresses

Primary practice location

26362 370TH Ave
Hillman, MN 56338-2349

Mailing address

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

Other names 1

  • Mille Lacs Family Health Center 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
O20041012001489 MN Part A Provider - Rural Health Clinic 4789577834 Practice locations: Hillman, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1326200411. Details of each certification follow.

Rural health clinic certification: CCN 243434

Legal name
MILLE LACS HEALTH SYSTEM
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 27, 2005
Last certification
Aug 15, 2017
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
26362 370TH Ave
Hillman, MN 56338-2349
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.

National Provider Directory

National Provider Directory
Part of
Mille Lacs Health System

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 8, 2015
Rebecca K Fossand Individual Corporate DirectorCao Jan 4, 2016
Amy S Ninham Individual W-2 Managing EmployeeCfo Mar 10, 2025
Elizabeth J Lundquist Individual Corporate DirectorBoard Member Jan 1, 2013
Andrew Knutson Individual W-2 Managing EmployeeCfo Jan 27, 2025
Robert a Athman Individual Corporate DirectorBoard Member Jan 1, 2025
Jean M Stafford Individual Corporate DirectorBoard Member Jan 13, 2022
Roger W Tramm Individual Corporate DirectorBoard Chair Jan 1, 2023
Anthony Hass Individual Corporate DirectorBoard Chair Jan 1, 2023
Tracy L Sam Individual Corporate DirectorBoard Member Jan 1, 2024
Louis P Gravel Individual Corporate DirectorBoard Member Jan 12, 2012
Patti J Hook Individual Corporate DirectorBoard Chair Sep 1, 1991
Arden Virnig Individual Corporate DirectorBoard Member Jan 1, 2001
Dennis Burr Individual Corporate DirectorBoard Chair Jan 8, 2015

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
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
Mille Lacs Health SystemOnamia, MN, CCN 243976 Rural health clinic Operational/Managerial Control Sep 9, 2008

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 63

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 63

NPI Registry JSON

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

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493164800000",
    "number": "1326200411",
    "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": "26362 370TH AVE",
            "city": "HILLMAN",
            "state": "MN",
            "postal_code": "563382349",
            "telephone_number": "320-277-3682",
            "fax_number": "320-277-3372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLE LACS HEALTH SYSTEM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MILLE LACS HEALTH SYSTEM",
        "enumeration_date": "2008-06-30",
        "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": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mille Lacs Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hillman, MN

Sources for this page

Verify at the official NPI Registry.