Pembina County Memorial Hospital Association

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1011B Issued in ND

Legal business name

PEMBINA COUNTY MEMORIAL HOSPITAL ASSOCIATION

Doing business as

Wedgewood Manor

Practice address

804 Main St W
Cavalier, ND 58220-4646

Phone

(701) 265-8453

NPI assigned

Jan 29, 2007

Last updated

Jul 25, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lisa Letexier

Title

Ceo

Phone

(701) 265-6228

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Wedgewood Manor Doing business as

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356487565. Details of each certification follow.

• CCN 355087 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 355087

Legal name

PEMBINA COUNTY MEMORIAL HOSPITAL ASSOCIATION

Doing business as

WEDGEWOOD MANOR

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Mar 6, 1980

Last certification

May 16, 2024

Beds

33

Ownership / control type

Other Nonprofit

Organization structure

CorporationNon-profit

Incorporated

Apr 3, 1946 in ND

Enrollment address

804 Main W St
Cavalier, ND 58220-4646

Nursing home name

WEDGEWOOD MANOR

Other NPIs with the same Medicare PAC ID 3

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

• Pembina County Memorial Hospital Association

  • Medicare Defined Swing Bed Hospital Unit
  • Cavalier, ND
  • NPI 1063634210

  4789643719

  Same PAC ID
• Pembina County Memorial Hospital Association

  dba Clinicare

  • Rural Health Clinic/Center
  • Cavalier, ND
  • NPI 1417093949

  4789643719

  Same PAC ID
• Pembina County Memorial Hospital Association

  • Critical Access Hospital
  • Cavalier, ND
  • NPI 1760542500

  4789643719

  Same PAC ID

Listed as

Wedgewood ManorCCN 355087 · All quality measures

Overall star rating

1 of 5

Health inspections

1 of 5

Staffing

4 of 5

Quality measures

1 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Other

Certified

Mar 6, 1980

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

3333.1 residents per day on average

Special focus status

SFF Candidate

Penalties (3 years)

1Fines totaling $54,925

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Pembina Cnty Mem Hosp Assoc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Pembina County Memorial Hospital Association

  dba Clinicare

  • Physician Assistant
  • Cavalier, ND
  • NPI 1205244944
  NPD tax ID
• Pembina County Memorial Hospital Association

  dba Clinicare

  • Rural Health Clinic/Center
  • Cavalier, ND
  • NPI 1417093949
  NPD tax ID

Locations

All disclosed owners & managing parties 16

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

Owners & managing parties with NPI records 5

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

• Pembina County Memorial Hospital Association

  • Medicare Defined Swing Bed Hospital Unit
  • Cavalier, ND
  • NPI 1063634210

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Pembina County Memorial Hospital Association

  dba Clinicare

  • Rural Health Clinic/Center
  • Cavalier, ND
  • NPI 1417093949

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Pembina County Memorial Hospital Association

  • Critical Access Hospital
  • Cavalier, ND
  • NPI 1760542500

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Kulvinder Sumra, MD

  • Family Medicine Physician
  • Cavalier, ND
  • NPI 1184760274

  Adp of the SNF, Corporate Director, Corporate Officer, Managing Control - Governing Body

  CMS ownership
• Susan J Thompson, MD

  • Internal Medicine Physician
  • Cavalier, ND
  • NPI 1245327899

  Corporate Director, Managing Control - Governing Body

  CMS ownership

Practitioners 4

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.

• Inder V Khokha, MD

  • Surgery Physician
  • Cavalier, ND
  • NPI 1225089949
  NPD (past)
• Renee Lee, FNP

  • Physician Assistant
  • Cavalier, ND
  • NPI 1104962299
  NPD (past)
• Kulvinder Sumra, MD

  • Family Medicine Physician
  • Cavalier, ND
  • NPI 1184760274
  NPD (past)
• Susan J Thompson, MD

  • Internal Medicine Physician
  • Cavalier, ND
  • NPI 1245327899
  NPD (past)

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Susan J Thompson, MD

  • Internal Medicine Physician
  • Cavalier, ND
  • NPI 1245327899

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658707200000",
    "number": "1356487565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 380",
            "city": "CAVALIER",
            "state": "ND",
            "postal_code": "582200380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 MAIN ST W",
            "city": "CAVALIER",
            "state": "ND",
            "postal_code": "582204646",
            "telephone_number": "701-265-8453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEMBINA COUNTY MEMORIAL HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A",
        "authorized_official_last_name": "LETEXIER",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "701-265-6228"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "ND",
            "license": "1011B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MEDICAID ID",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wedgewood Manor",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wedgewood Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mark Elliot Olson, DDS
• Judy A Pegg, PA-C
• Pembina County (Pembina County Social Services)
• Pembina County Memorial Hospital Association
• Pembina County Memorial Hospital Association (Clinicare)
• Pembina County Memorial Hospital Association (Clinicare)
• Pembina County Memorial Hospital Association
• Pembina Special Education Cooperative
• Jennifer Jean Puppe, LBSW
• Rehab Products Inc

• Skilled Nursing Facility in Cavalier, ND
• Providers in Cavalier, ND by specialty
• Skilled Nursing Facility in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.