Johnson Memorial Health Services
Organization Active NPI Rural Health Clinic/Center · Boyd, MN
NPI 1457466716 · NPPES record last updated May 12, 2026
Key facts
- NPI
- 1457466716
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- JOHNSON MEMORIAL HEALTH SERVICES
- Practice address
- 115 3Rd St
Boyd, MN 56218 - Phone
- (320) 855-2290
- Fax
- (320) 855-2294
- NPI assigned
- Aug 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Jonell Leslie
- Title
- Credentialing Coordinator
- Phone
- (320) 312-2145
Owners & managing parties with NPI records 4
Owned or controlled facilities with NPI records 4
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 4
Related certifications (CCN) 1
Facilities with the same owner 1
Practitioners 17
-
Bruce Wesley Arvold, M.D.
-
Lisa D Bojado, NP
-
Lindsey Anne Hanson, M.D., M.P.H
-
Carla Rae Lee, C.F.N.P
-
Jessica Marie Mamer, FNP
-
Julie A Olson, PA-C, FNP
-
Miriam V Ragab, DO
-
Erik J Shelstad, M.D,
-
Yuan Stevenson, M.D.
-
Ayaz Virji, M.D
-
Noah N Chelliah, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
Rural health clinic certification: CCN 243426
- Legal name
- JOHNSON MEMORIAL HEALTH SERVICES
- Doing business as
- BOYD CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Feb 18, 2003
- Last certification
- Mar 13, 2014
- Ownership / control type
- 2B
- Organization structure
- Government · Non-profit
- Incorporated
- Nov 21, 1972 in MN
- Enrollment address
- 115 N 3Rd Street
Boyd, MN 56218 - Related CCNs
- 241314
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Johnson Memorial Health Services |
Operational/Managerial Control | Nov 21, 1972 | 100% |
| Crystal Bothun |
Corporate Officer |
Aug 7, 2024 | |
| W-2 Managing Employee |
Aug 7, 2024 | ||
| Jacob William Redepenning |
Corporate Officer |
Nov 18, 2024 | |
| W-2 Managing Employee |
Nov 18, 2024 |
All facility ownership & control disclosures 4
| Facility | Type | Role | Since |
|---|---|---|---|
| Johnson Memorial Hospital |
Hospital | Other (100%) | Nov 21, 1972 |
| Johnson Memorial Hospital |
Hospital | Other (100%) | Nov 21, 1972 |
| Johnson Memorial Nursing Home |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jun 6, 1972 |
| Dawson Clinic |
Rural health clinic | Other (100%) | Nov 21, 1972 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20021029000029 | MN | Part a Provider - Rural Health Clinic | 5395653836 | Practice locations: Boyd, MN |
| O20031223000327 | MN | Part B Supplier - Clinic/Group Practice | 5395653836 |
Receives reassigned benefits from 32 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Boyd, MN; Dawson, MN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | MN | Yes |
Addresses
Primary practice location
115 3Rd St
Boyd, MN 56218
Mailing address
1282 Walnut St
Dawson, MN 56232-2333
Phone (320) 769-4393
Other names
- Boyd Community Health Center
Other providers in Boyd, MN
All providers in Boyd, 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 May 12, 2026. 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.