NPIMap

Organization Active NPI

Coal Country Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Killdeer, ND
National Provider Identifier
1407235575
Registry record updated Jan 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COAL COUNTRY COMMUNITY HEALTH CENTER
Practice address
220 4TH Ave SW
Killdeer, ND 58640-8500
Phone
(701) 764-5822
Fax
(701) 639-4731
NPI assigned
May 22, 2015
Last updated
Jan 8, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2026

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

Authorized official

Name
Kurt Waldbillig
Title
Ceo
Phone
(701) 873-4445

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

220 4TH Ave SW
Killdeer, ND 58640-8500

Mailing address

1312 Highway 49 N
Beulah, ND 58523-6038
Phone (701) 764-5822

Other identifiers 1

IdentifierTypeStateIssuer
1464996MedicaidND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040317001173 ND Part B Supplier - Clinic/Group Practice 9436042892 Receives reassigned benefits from 20 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Beulah, ND; Killdeer, ND; Hazen, ND; Center, ND
O20150909002323 ND Part A Provider - Federally Qualified Health Center (FQHC) 9436042892 Practice locations: Killdeer, ND
O20191118000516 ND MDPP Supplier - in-Person MDPP Supplier 9436042892 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Killdeer, ND; Hazen, ND; Center, ND; Beulah, ND

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407235575. Details of each certification follow.

Federally qualified health center certification: CCN 351818

Legal name
COAL COUNTRY COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 21, 2015
Last certification
Aug 21, 2015
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Apr 23, 2003 in ND
Enrollment address
220 4TH Ave SW
Killdeer, ND 58640-8500

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
35D2100388Coal Country Community Health Center220 4TH Ave SW Suite C, Killdeer, ND 58640ComplianceJan 18, 2028

National Provider Directory

National Provider Directory

Locations

1312 Highway 49 N
Beulah, ND 58523
Phone (701) 873-4445

220 4th Ave SW
Killdeer, ND 58640
Phone (701) 764-5822

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Darrold Bertsch Individual Corporate DirectorBoard Member Jul 1, 2024
Bill Zingg Individual Corporate DirectorBoard Member Jul 1, 2024
Aaron M Garman Individual W-2 Managing EmployeeMedical Director Dec 1, 2003
Kathy Kelsch Tomchuck Individual Corporate DirectorBoard Member May 23, 2018
Dakota Certified Development Corporation Organization, Fargo, ND Created for acquisition, Financial institution 5% Or Greater Mortgage Interest Sep 29, 2009 2.5%
Brandon Zahn Individual Corporate DirectorBoard Member Jul 1, 2024
Sarah Duttenhefner Individual Corporate DirectorBoard Member May 30, 2023
Frederick Stern Individual Corporate DirectorBoard Member May 1, 2012
Wayne Hoffner Individual Corporate DirectorBoard Member Mar 24, 2021
William Suter Individual Corporate DirectorBoard Member May 30, 2023
Brian Nolan Individual Corporate DirectorBoard Member Jun 21, 2023
Heidi Moore Individual Corporate DirectorBoard Member Jan 29, 2020
Kurt V Waldbillig Individual Corporate OfficerCeo Nov 1, 2023
Donlyn J Erickson Individual Corporate DirectorBoard Member Dec 1, 2003
Sharon Rud Individual Corporate DirectorBoard Member Mar 24, 2021
Myria Perry Individual Corporate DirectorBoard Member Feb 23, 2022
David Whipps Individual Corporate OfficerCfo Mar 1, 2025
Martha Gunderson Individual Corporate DirectorBoard Member Jul 1, 2024

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1432252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767830400000",
    "number": "1407235575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1312 HIGHWAY 49 N",
            "city": "BEULAH",
            "state": "ND",
            "postal_code": "585236038",
            "telephone_number": "701-764-5822",
            "fax_number": "701-639-4731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 4TH AVE SW",
            "city": "KILLDEER",
            "state": "ND",
            "postal_code": "586408500",
            "telephone_number": "701-764-5822",
            "fax_number": "701-639-4731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COAL COUNTRY COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-22",
        "last_updated": "2026-01-08",
        "certification_date": "2026-01-08",
        "status": "A",
        "authorized_official_last_name": "WALDBILLIG",
        "authorized_official_first_name": "KURT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "701-873-4445"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1464996",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Killdeer, ND

Sources for this page

Verify at the official NPI Registry.