Mille Lacs Health System
Organization Active NPI Rural Health Clinic/Center · Hillman, MN
NPI 1326200411 · NPPES record last updated Apr 26, 2017
Key facts
- NPI
- 1326200411
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- MILLE LACS HEALTH SYSTEM
- Practice address
- 26362 370TH Ave
Hillman, MN 56338-2349 - Phone
- (320) 277-3682
- Fax
- (320) 277-3372
- NPI assigned
- Jun 30, 2008
- Organization subpart
- Yes
- Parent organization (as reported)
- MILLE LACS HEALTH SYSTEM
Authorized official
- Name
- Mr. John W Unzen
- Title
- Cfo
- Phone
- (320) 532-2581
Owners & managing parties with NPI records 3
-
Patti Jean Hook, M.D.
-
Arden Edward Virnig, M.D.
Owned or controlled facilities with NPI records 4
Other NPIs on the same Medicare enrollment 9
Other NPIs with the same Medicare PAC ID 9
Related certifications (CCN) 1
Practitioners 79
-
Thomas Howard Bracken, M.D.
-
Jessica Anne Fligge, D.N.P. APRN-BC, CNP
-
Ryan Michael Fox, MD
-
Nash Redmond Gleason, PHYSICIAN ASSISTANT
-
Patti Jean Hook, M.D.
-
Fahad Khemani, MD
-
Nicole Loxterkamp, APRN, NP-C
-
Susana Njuakom, NP
-
Juliette Power, MD
-
John Andrew Schoenhard, MD, PHD
-
Alejandra Soto, PA-C
-
Cassandra Jacqueline Talberg, APRN FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
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
- Corporation · Non-profit
- Enrollment address
- 26362 370TH Ave
Hillman, MN 56338-2349 - Related CCNs
- 241356
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Robert Dubbs |
Corporate Director |
Jan 8, 2015 | |
| Rebecca K Fossand |
Corporate Director |
Jan 4, 2016 | |
| Amy S Ninham |
W-2 Managing Employee |
Mar 10, 2025 | |
| Elizabeth J Lundquist |
Corporate Director |
Jan 1, 2013 | |
| Andrew Knutson |
W-2 Managing Employee |
Jan 27, 2025 | |
| Robert a Athman |
Corporate Director |
Jan 1, 2025 | |
| Jean M Stafford |
Corporate Director |
Jan 13, 2022 | |
| Roger W Tramm |
Corporate Director |
Jan 1, 2023 | |
| Anthony Hass |
Corporate Director |
Jan 1, 2023 | |
| Tracy L Sam |
Corporate Director |
Jan 1, 2024 | |
| Louis P Gravel |
Corporate Director |
Jan 12, 2012 | |
| Patti J Hook |
Corporate Director |
Sep 1, 1991 | |
| Arden Virnig |
Corporate Director |
Jan 1, 2001 | |
| Dennis Burr |
Corporate Director |
Jan 8, 2015 |
All facility ownership & control disclosures 4
| Facility | Type | Role | Since |
|---|---|---|---|
| Cura of Onamia |
Skilled nursing facility | Adp of the SNF | Jul 22, 2002 |
| Mille Lacs Health System |
Hospice | Operational/Managerial Control | Jun 17, 2009 |
| Mille Lacs Health System |
Rural health clinic | Operational/Managerial Control | Sep 10, 2008 |
| Mille Lacs Health System |
Rural health clinic | Operational/Managerial Control | Sep 9, 2008 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Part of
- Mille Lacs Family Clini
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes | ||
| Medical Physician Assistant |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 115808 | Other | MN | UCARE MINNESOTA |
| 33523MI | Other | MN | BLUE CROSS BLUE SHIELD MINNESOTA |
| 630994100 | Medicaid | MN |
Other names
- Mille Lacs Family Health Center
Other providers in Hillman, MN
All providers in Hillman, MN · Rural Health Clinic/Center in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 26, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.