NPIMap

Organization Active NPI

Northwood Deaconess Health Center

  • Rural Health Clinic/Center
  • Northwood, ND
National Provider Identifier
1477964674
Registry record updated May 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
NORTHWOOD DEACONESS HEALTH CENTER
Practice address
4 N Park St
Northwood, ND 58267-4102
Phone
(701) 587-6060
Fax
(701) 587-6492
NPI assigned
May 12, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2025

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

Authorized official

Name
Brock Sherva
Title
Ceo
Phone
(701) 587-6060

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

4 N Park St
Northwood, ND 58267-4102

Mailing address

PO Box 190
Northwood, ND 58267-4102
Phone (701) 587-6060

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040226000123 ND Part B Supplier - Clinic/Group Practice 1052207057 Receives reassigned benefits from 22 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Northwood, ND
O20140716002179 ND Part A Provider - Rural Health Clinic 1052207057 Practice locations: Northwood, ND

Rural health clinic certification: CCN 353455

Legal name
NORTHWOOD DEACONESS HEALTH CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 23, 2014
Last certification
Dec 2, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Mar 3, 1902 in ND
Enrollment address
4 N Park St
Northwood, ND 58267-4102
Related CCNs
351312

Facilities connected through Provider of Services related, parent or unit certification numbers.

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 5

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

National Provider Directory

National Provider Directory
Tax ID family
Northwood Deaconess Health3 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.

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Keith Groven Individual Corporate Director Mar 26, 2019
Judy Engen Individual Corporate Director Mar 26, 2019
Lonney Eastvold Individual Corporate Director Mar 25, 2016
Peter L Antonson Individual Corporate OfficerCeo Sep 1, 2014 100%
Corporate DirectorCeo Sep 1, 2014 100%
Joan Thompson Individual Corporate Director Mar 30, 2021
Greg McMahon Individual Corporate Director Mar 26, 2019
Tina M Schwartz Individual W-2 Managing EmployeeClinic Manager Sep 1, 2014 100%
Patrick Askew Individual Corporate Director Jan 25, 2022
Robert Bilden Individual Corporate OfficerBoard Memeber Mar 27, 2014

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Northwood Deaconess Health CenterNorthwood, ND, CCN 35Z312 Hospital Operational/Managerial Control Jan 1, 1990

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1399852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748304000000",
    "number": "1477964674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190",
            "city": "NORTHWOOD",
            "state": "ND",
            "postal_code": "582674102",
            "telephone_number": "701-587-6060",
            "fax_number": "701-587-6492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 N PARK ST",
            "city": "NORTHWOOD",
            "state": "ND",
            "postal_code": "582674102",
            "telephone_number": "701-587-6060",
            "fax_number": "701-587-6492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWOOD DEACONESS HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-12",
        "last_updated": "2025-05-27",
        "certification_date": "2025-05-27",
        "status": "A",
        "authorized_official_last_name": "SHERVA",
        "authorized_official_first_name": "BROCK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "701-587-6060"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Northwood, ND

Sources for this page

Verify at the official NPI Registry.