NPIMap

Organization Active NPI

First Care Medical Services

Doing business as Essentia Health Fosston

  • Critical Access Hospital
  • Fosston, MN
National Provider Identifier
1497850119
Registry record updated Oct 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
FIRST CARE MEDICAL SERVICES
Doing business as
Essentia Health Fosston
Practice address
900 Hilligoss Blvd SE
Fosston, MN 56542-1542
Phone
(218) 435-1133
Fax
(218) 435-1134
NPI assigned
Sep 14, 2006
Last updated
Oct 1, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2021

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

Authorized official

Name
Kim Bodensteiner
Title
Cfo
Phone
(218) 435-7633

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X NU Primary

Addresses

Primary practice location

900 Hilligoss Blvd SE
Fosston, MN 56542-1542

Mailing address

900 Hilligoss Blvd SE
Fosston, MN 56542-1542
Phone (218) 435-1133

Other identifiers 4

IdentifierTypeStateIssuer
7T834FIOtherMNBLUE CROSS NUMBER
1008426OtherMNPREFERRED ONE GROUP #
2469OtherMNHEALTHPARTNERS GROUP #
381347900MedicaidMN

Other names 1

  • Essentia Health Fosston Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040927000035 MN Part B Supplier - Clinic/Group Practice 3678542842 Receives reassigned benefits from 106 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bagley, MN; Fosston, MN; Oklee, MN
O20060504000670 MN Part A Provider - Critical Access Hospital 3678542842 Receives reassigned benefits from 98 practitioners
1 other NPI on this enrollment
Practice locations: Fosston, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497850119. Details of each certification follow.

Hospital certification: CCN 241357

Legal name
FIRST CARE MEDICAL SERVICES
Doing business as
ESSENTIA HEALTH FOSSTON
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Aug 1, 2004
Last certification
Mar 20, 2024
Beds
50
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
May 26, 1947 in MN
Enrollment address
900 Hilligoss Blvd SE
Fosston, MN 56542-1542

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

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 3

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Essentia Health FosstonCCN 241357 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Stefanie Gefroh Ellison Individual Corporate OfficerPresident Aug 12, 2024
Tim D Heilman Individual Corporate DirectorBoard Member Jan 1, 2020
Aarick L Jackson Individual Corporate DirectorBoard Member Jan 1, 2020
Mark Gordon Finstad Individual Corporate DirectorBoard Member Feb 15, 2022
James M Christensen Individual Corporate DirectorBoard Member Jan 1, 2020
Taylor Grant Mertz Individual Corporate DirectorBoard Member May 17, 2022
Michael Watters Individual Corporate DirectorSecretary Jul 1, 2023
Alan J Hurley Individual Corporate OfficerCoo May 18, 2023
W-2 Managing Employee May 18, 2023
Beverly Mary Horn Individual Corporate DirectorBoard Member Jan 1, 2017
Benjamin Cody Smith Individual Corporate DirectorBoard Member May 17, 2022
Douglas J Arvin Individual Corporate OfficerVP of Finance / Cfo May 18, 2023
W-2 Managing EmployeeVP of Finance / Cfo May 18, 2023
Joel Ross Haugen Individual Corporate DirectorBoard Member Jan 1, 2017
Laurie Ann Lewandowski Individual Corporate DirectorBoard Member Jan 1, 2017
Innovis Health LLC Organization, Fargo, ND LLC, Non-profit Operational/Managerial Control Jan 1, 2017

Owners & managing parties with NPI records 11

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

Facilities with the same owner 23

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

View all 23

Practitioners & affiliated clinicians

Practitioners 103

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.

View all 103

Affiliated clinicians 87

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

View all 87

NPI Registry JSON

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633046400000",
    "number": "1497850119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 HILLIGOSS BLVD SE",
            "city": "FOSSTON",
            "state": "MN",
            "postal_code": "565421542",
            "telephone_number": "218-435-1133",
            "fax_number": "218-435-1134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 HILLIGOSS BLVD SE",
            "city": "FOSSTON",
            "state": "MN",
            "postal_code": "565421542",
            "telephone_number": "218-435-1133",
            "fax_number": "218-435-1134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST CARE MEDICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2021-10-01",
        "certification_date": "2021-10-01",
        "status": "A",
        "authorized_official_last_name": "BODENSTEINER",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "218-435-7633"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS NUMBER",
            "identifier": "7T834FI",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE GROUP #",
            "identifier": "1008426",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS GROUP #",
            "identifier": "2469",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "381347900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Fosston",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Essentia Health Fosston",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fosston, MN

Sources for this page

Verify at the official NPI Registry.