Luther Memorial Home

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1039A Issued in ND

Legal business name

LUTHER MEMORIAL HOME

Practice address

750 Main St E
Mayville, ND 58257-1606

Phone

(701) 786-3401

Fax

(701) 786-9022

NPI assigned

Jul 26, 2005

Last updated

Oct 11, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brett Ulrich

Title

Administrator

Phone

(701) 786-3401

Specialties & licenses 3

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497755185. Details of each certification follow.

• CCN 355040 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 355040

Legal name

LUTHER MEMORIAL HOME

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jun 1, 1978

Last certification

Oct 10, 2024

Beds

62

Ownership / control type

Nonprofit Corporation

Organization structure

CorporationNon-profit

Incorporated

May 15, 1957 in ND

Enrollment address

750 Main St E
Mayville, ND 58257-1606

Nursing home name

LUTHER MEMORIAL HOME

Listed as

Luther Memorial HomeCCN 355040 · All quality measures

Overall star rating

4 of 5

Health inspections

3 of 5

Staffing

5 of 5

Quality measures

3 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Corporation

Certified

Jun 1, 1978

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

6260.6 residents per day on average

Penalties (3 years)

1Fines totaling $5,814

Processed by Care Compare on Aug 1, 2026.

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

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 13

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

Owners & managing parties with NPI records 8

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

• James G Mehus, MD

  • Internal Medicine Physician
  • Mayville, ND
  • NPI 1497772032

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Sanford Clinic

  dba Sanford Virtual Health Services

  • Diagnostic Radiology Physician
  • Fargo, ND
  • NPI 1306641345

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Sanford Clinic

  dba Sanford Vascular Associates

  • Surgery Physician
  • Sioux Falls, SD
  • NPI 1194733535

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Sanford Clinic

  • Family Medicine Physician
  • Sioux Falls, SD
  • NPI 1255353934

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Sanford Clinic

  dba Sanford Health Pathology Clinic

  • Clinical Medical Laboratory
  • Sioux Falls, SD
  • NPI 1326311721

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Sanford Clinic

  dba Sanford Health Psychiatry & Psychology Clinic

  • Psychologist
  • Sioux Falls, SD
  • NPI 1396764254

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Sanford Clinic

  dba Sanford Clinic Optical Shop

  • Eyewear Supplier
  • Sioux Falls, SD
  • NPI 1710919741

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Sanford Clinic

  dba Sanford Clinic Radiology

  • Diagnostic Radiology Physician
  • Sioux Falls, SD
  • NPI 1912932997

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Practitioners 2

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.

• James G Mehus, MD

  • Internal Medicine Physician
  • Mayville, ND
  • NPI 1497772032
  NPD (past)
• Jane Ostlie, MD

  • Family Medicine Physician
  • Mayville, ND
  • NPI 1063672749
  NPD (past)

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• James G Mehus, MD

  • Internal Medicine Physician
  • Mayville, ND
  • NPI 1497772032

  Nursing home

  Care Compare affiliation
• Jane Ostlie, MD

  • Family Medicine Physician
  • Mayville, ND
  • NPI 1063672749

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1122336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192060800000",
    "number": "1497755185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 MAIN ST E",
            "city": "MAYVILLE",
            "state": "ND",
            "postal_code": "582571606",
            "telephone_number": "701-786-3401",
            "fax_number": "701-786-9022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 MAIN ST E",
            "city": "MAYVILLE",
            "state": "ND",
            "postal_code": "582571606",
            "telephone_number": "701-786-3401",
            "fax_number": "701-786-9022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUTHER MEMORIAL HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-26",
        "last_updated": "2007-10-11",
        "status": "A",
        "authorized_official_last_name": "ULRICH",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "701-786-3401"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "ND",
            "license": "027",
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "ND",
            "license": "AL23",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "ND",
            "license": "1039A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30024",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN BLUE CROSS BLUE SHIELD",
            "identifier": "9846LU",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3050271 00",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ND BLUE CROSS BLUE SHIELD",
            "identifier": "001115",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cathi Hanson
• Nicholas Huss
• Natasha Ann Jones
• Jamie Kauffman, OTR/L
• Robert C Lauf, DDS
• James G Mehus, MD
• Michael Rexine OD PC (Eyes On Broadway)
• Timothy Obrien, LAT, ATC
• Patricia Marie Ogburn
• Inez Marie Olson, LPN

• Skilled Nursing Facility in Mayville, ND
• Providers in Mayville, ND by specialty
• Skilled Nursing Facility in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.