Active NPI
Trinity Health
- Family Medicine Physician
- Williston, ND
National Provider Identifier
1396784146
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- TRINITY HEALTH
- Doing business as
- Trinity Community Clinic Western Dakota
- Practice address
- 1102 Main St
Williston, ND 58801-4233 - Phone
- (701) 572-7711
- Fax
- (701) 572-2283
- NPI assigned
- Jun 6, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. John M Kutch
- Title
- President & Ceo
- Phone
- (701) 418-8000
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
1102 Main St
Williston, ND 58801-4233
Mailing address
PO Box 5020
Minot, ND 58702-5020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 18640 | Medicaid | ND |
Other names 1
- Trinity Community Clinic Western Dakota
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ND
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031106000316 | ND | Part B Supplier - Clinic/Group Practice | 7911816020 |
Receives reassigned benefits from 354 practitioners 13 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Minot, ND; Williston, ND; Velva, ND; New Town, ND; Mohall, ND; Devils Lake, ND; Garrison, ND |
Other NPIs on the same Medicare enrollment 13
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Oral and Maxillofacial Surgery Clinic/Center
- Minot, ND
- NPI 1245272277
O20031106000316
-
- Durable Medical Equipment & Medical Supplies
- Williston, ND
- NPI 1942355300
O20031106000316
National Provider Directory
National Provider DirectoryLocations
131 N Main St
Garrison, ND 58540
Phone (701) 463-2626
315 Main St S
Minot, ND 58701
Phone (701) 293-9829
2905 Elk Dr
Minot, ND 58701
Phone (701) 837-6508
420 3rd St SE
Minot, ND 58701
Phone (701) 857-2719
315 3rd St SE
Minot, ND 58701
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149552000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1747267200000",
"number": "1396784146",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5020",
"city": "MINOT",
"state": "ND",
"postal_code": "587025020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1102 MAIN ST",
"city": "WILLISTON",
"state": "ND",
"postal_code": "588014233",
"telephone_number": "701-572-7711",
"fax_number": "701-572-2283"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TRINITY HEALTH",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-06",
"last_updated": "2025-05-15",
"certification_date": "2025-05-15",
"status": "A",
"authorized_official_last_name": "KUTCH",
"authorized_official_first_name": "JOHN",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "PRESIDENT & CEO",
"authorized_official_telephone_number": "701-418-8000",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "18640",
"state": "ND"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Trinity Community Clinic Western Dakota",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Williston, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.