NPIMap

Organization Active NPI

CCM Health

  • Rural Health Clinic/Center
  • Marshall, MN
National Provider Identifier
1487436655
Registry record updated Oct 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CCM HEALTH
Practice address
1401 Nwakama St Ste 100
Marshall, MN 56258-5530
Phone
(320) 269-8877
NPI assigned
Oct 20, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2023

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

Authorized official

Name
Desi Anspach
Title
Cfo
Phone
(320) 321-8201

Specialties & licenses 1

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

Addresses

Primary practice location

1401 Nwakama St Ste 100
Marshall, MN 56258-5530

Mailing address

824 N 11TH St
Montevideo, MN 56265-1629
Phone (320) 269-8877

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231208001316 MN Part A Provider - Rural Health Clinic 4284539453 Practice locations: Marshall, MN

Rural health clinic certification: CCN 248503

Legal name
CCM HEALTH
Doing business as
CCM HEALTH - MARSHALL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 5, 2024
Last certification
Aug 5, 2024
Ownership / control type
2B
Organization structure
GovernmentNon-profit
Incorporated
Jan 1, 2002 in MN
Enrollment address
1401 Nwakama St
Ste 100
Marshall, MN 56258-5530
Related CCNs
241325

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

Other NPIs with the same Medicare PAC ID 6

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

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
24D2292639CCM Health - Marshall1401 Nwakama Street Suite 100, Marshall, MN 56258Certificate of waiverOct 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Chippewa County Montevideo7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1401 Nwakama St
Ste 300
Marshall, MN 56258
Phone (507) 929-7696

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
City of Montevideo Organization, Montevideo, MN 5% Or Greater Direct Ownership Interest Nov 17, 2007 50%
Deserae Anspach Individual Corporate OfficerCfo Feb 19, 2023
Lydia D Kranz Individual W-2 Managing EmployeeMedical Staff Services Manager Jan 1, 2019
Brian a Lovdahl Individual Corporate OfficerCeo Jun 1, 2018
Chippewa County Organization, Montevideo, MN 5% Or Greater Direct Ownership Interest Nov 12, 2007 50%

Facilities with the same owner 6

Facilities that share an organizational owner with 5% or greater ownership or operational control.

  • CCM Health
    • Home Health Agency
    • Montevideo, MN
    • NPI 1275751950

    Chippewa County, City of Montevideo

    CMS ownership
  • CCM Health
    • Medicare Defined Swing Bed Hospital Unit
    • Montevideo, MN
    • NPI 1346460755

    Chippewa County, City of Montevideo

    CMS ownership
  • CCM Health
    • Rural Health Clinic/Center
    • Montevideo, MN
    • NPI 1407636475

    Chippewa County, City of Montevideo

    CMS ownership
  • CCM Health
    • Rural Health Clinic/Center
    • Milan, MN
    • NPI 1457132466

    Chippewa County, City of Montevideo

    CMS ownership
  • CCM Health
    • Rural Health Clinic/Center
    • Clara City, MN
    • NPI 1679354690

    Chippewa County, City of Montevideo

    CMS ownership
  • CCM Health
    • Critical Access Hospital
    • Montevideo, MN
    • NPI 1720086028

    Chippewa County, City of Montevideo

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 69

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

View all 69

NPI Registry JSON

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

{
    "created_epoch": "1697760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697760000000",
    "number": "1487436655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 N 11TH ST",
            "city": "MONTEVIDEO",
            "state": "MN",
            "postal_code": "562651629",
            "telephone_number": "320-269-8877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 NWAKAMA ST STE 100",
            "city": "MARSHALL",
            "state": "MN",
            "postal_code": "562585530",
            "telephone_number": "320-269-8877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCM HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-20",
        "last_updated": "2023-10-20",
        "certification_date": "2023-10-20",
        "status": "A",
        "authorized_official_last_name": "ANSPACH",
        "authorized_official_first_name": "DESI",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "320-321-8201"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marshall, MN

Sources for this page

Verify at the official NPI Registry.