St Mary'S Regional Health Center
Organization Active NPI Rural Health Clinic/Center · Menahga, MN
NPI 1467798322 · NPPES record last updated Mar 1, 2024
Key facts
- NPI
- 1467798322
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- ST MARY'S REGIONAL HEALTH CENTER
- Practice address
- 212 Aspen Ave NE
Menahga, MN 56464-3289 - Phone
- (218) 564-4131
- Fax
- (218) 564-5287
- NPI assigned
- Dec 21, 2012
- Organization subpart
- Yes
- Parent organization (as reported)
- ESSENTIA HEALTH
Authorized official
- Name
- Alan James Hurley
- Title
- Coo
- Phone
- (701) 364-7667
Owners & managing parties with NPI records 11
-
Benjamin C Smith, MD
Other NPIs on the same Medicare enrollment 22
Other NPIs with the same Medicare PAC ID 11
Member of 1
Related certifications (CCN) 3
Facilities with the same owner 50
Practitioners 200
-
Rachel Diane Erickson, APRN, CNP
-
Paige Nicole Feist, APRN,CNP
-
Rachel Koch, NURSE PRACTITIONER
-
Jenna B Mazour, APRN,CNP
-
Anna Joy Neu, FNP
-
Tamera Ostenaa, APRN, CNP
-
Leah R Radke, APRN,CNP
-
Tera Jo Kinslow, FNP-C
-
Alexandra D Kohlhase, PSYD
-
Ryan Ahlgren, NP
-
Molly Mae Anderson, PMHNP
-
Anita Bagstad, APRN,CNP
-
Susan Bauer, D.O.
-
Benita Behm, MD
-
Sarah A Bement, PA-C
-
David C Benson, MD
-
Kari J Bergman, APRN, CNP
-
Lisa D Bojado, NP
-
Tricia Rae Brein, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in MN
Rural health clinic certification: CCN 243475
- Legal name
- ST MARYS REGIONAL HEALTH CENTER
- Doing business as
- ESSENTIA HEALTH MENAHGA CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jun 21, 2016
- Last certification
- Jun 21, 2016
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 11, 1989 in MN
- Enrollment address
- 212 Aspen Ave NE
Menahga, MN 56464-3289 - Related CCNs
- 240101
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Stefanie Gefroh Ellison |
Corporate Officer |
Aug 12, 2024 | |
| Tim D Heilman |
Corporate Director |
Jan 1, 2020 | |
| Marc Adams |
Corporate Director |
Jan 1, 2026 | |
| Mark Krejci |
Corporate Director |
Jan 1, 2026 | |
| Kimberly Pladson |
Corporate Director |
Jan 1, 2025 | |
| Essentia Health |
5% Or Greater Direct Ownership Interest | Jul 1, 2023 | 100% |
| James M Christensen |
Corporate Director |
Jan 1, 2020 | |
| Kevin S Boren |
Corporate Officer |
Sep 29, 2025 | |
| Taylor Grant Mertz |
Corporate Director |
May 17, 2022 | |
| Anderson Saint Georges |
Corporate Director |
Jan 1, 2025 | |
| Michael Watters |
Corporate Officer |
Jul 1, 2023 | |
| Alan J Hurley |
Corporate Officer |
May 18, 2023 | |
| W-2 Managing Employee |
May 18, 2023 | ||
| Benjamin Cody Smith |
Corporate Director |
May 17, 2022 | |
| Douglas J Arvin |
Corporate Officer |
May 18, 2023 | |
| W-2 Managing Employee |
May 18, 2023 | ||
| Laurie Ann Lewandowski |
Corporate Director |
Jan 1, 2017 | |
| Innovis Health LLC |
Operational/Managerial Control | Jan 1, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031117000090 | MN | Part B Supplier - Clinic/Group Practice | 2062326820 |
Receives reassigned benefits from 290 practitioners 13 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Frazee, MN; Lake Park, MN; Mahnomen, MN; Menahga, MN; Park Rapids, MN; Pelican Rapids, MN; Walker, MN; Detroit Lakes, MN |
| O20080115000831 | MN | Part B Supplier - Clinic/Group Practice | 9931298155 |
Receives reassigned benefits from 108 practitioners 12 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Fergus Falls, MN; Wheaton, MN; Ulen, MN; Twin Valley, MN; Thief River Falls, MN; Park Rapids, MN; Moorhead, MN; Duluth, MN… |
| O20151007000243 | MN | Part a Provider - Rural Health Clinic | 2062326820 | Practice locations: Menahga, MN |
National Provider Directory
Locations
212 Aspen Ave NE
Menahga, MN 56464
Phone (218) 564-4131
1630 101st Ave NE
Ste 140
Minneapolis, MN 55449
Phone (763) 703-3509
7475 Tamarack Rd
#120
Woodbury, MN 55125
Phone (651) 348-6989
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
212 Aspen Ave NE
Menahga, MN 56464-3289
Mailing address
1027 Washington Ave
Detroit Lakes, MN 56501-3409
Phone (218) 847-5611
Other names
- Essentia Health Menahga Clinic
Other providers in Menahga, MN
- Rose Haven
- Rose Haven Assisted Living Incorporated
- Seip Drug LLC
- Jared Skoog
- Snyders Drug
- St Mary'S Regional Health Center
- Kami Rose Steinbach
All providers in Menahga, 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 Mar 1, 2024. 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.