NPIMap

Organization Active NPI

International Falls Memorial Hospital Association

Doing business as Rainy Lake Medical Center

  • Rural Health Clinic/Center
  • Littlefork, MN
National Provider Identifier
1508378324
Registry record updated Jun 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
INTERNATIONAL FALLS MEMORIAL HOSPITAL ASSOCIATION
Doing business as
Rainy Lake Medical Center
Practice address
912 Main St Unit C
Littlefork, MN 56653-9379
Phone
(218) 278-2000
Fax
(218) 278-2020
NPI assigned
Nov 2, 2017
Last updated
Jun 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2021

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

Authorized official

Name
Mr. Robert Pastor
Title
Ceo
Phone
(218) 283-5488

Specialties & licenses 1

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

Addresses

Primary practice location

912 Main St Unit C
Littlefork, MN 56653-9379

Mailing address

1400 Highway 71
International Falls, MN 56649-2154
Phone (218) 283-4481

Other identifiers 1

IdentifierTypeStateIssuer
243987OtherMNMEDICARE

Other names 1

  • Rainy Lake Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160216001354 MN Part A Provider - Rural Health Clinic 1951365998 1 other NPI on this enrollment
Practice locations: Littlefork, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508378324. Details of each certification follow.

Rural health clinic certification: CCN 243987

Legal name
INTERNATIONAL FALLS MEMORIAL HOSPITAL ASSOCIATION
Doing business as
RAINY LAKE MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 12, 1995
Last certification
Nov 20, 2019
Ownership / control type
2B
Most recent change of ownership
Feb 1, 2016 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Sep 12, 1945 in MN
Enrollment address
912 Main St
Unit C
Littlefork, MN 56653-9379
Related CCNs
241322

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 1

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

National Provider Directory

National Provider Directory
Tax ID family
International Falls Memorial Hospital Association5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
John Lawrence Winkel Individual Corporate OfficerBoard Member Aug 1, 2023
Craig O Boyer Individual Corporate OfficerCfo Feb 20, 2023
W-2 Managing EmployeeCfo Feb 20, 2023
Richard Peterson Individual Corporate DirectorBoard of Trustee President Jan 31, 2017
Brian Briggs Individual Corporate DirectorBoard Member Aug 23, 2013
Susan Congrave Individual Corporate DirectorBoard Member Apr 1, 2004
Don Billig Individual Corporate DirectorBoard Member Apr 1, 2001
Sherri Mannausau Individual Corporate DirectorBoard Member Jan 23, 2020
Robert L Pastor Individual Corporate OfficerCeo Sep 1, 2018
W-2 Managing EmployeeCeo Sep 1, 2018
Steven G Lindberg Individual Corporate DirectorBoard Member Mar 16, 2018
Brian Rauzi Individual Corporate OfficerCoo Jan 1, 2021
W-2 Managing EmployeeExecutive Director of Operations Dec 1, 2015

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Littlefork Care CenterLittlefork, MN, CCN 245542 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Apr 1, 2016
Oct 23, 2025
Rainy Lake Medical CenterInternational Falls, MN, CCN 243469 Rural health clinic Operational/Managerial Control (100%) Aug 21, 2013

Owned or controlled facilities with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1509580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622592000000",
    "number": "1508378324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 HIGHWAY 71",
            "city": "INTERNATIONAL FALLS",
            "state": "MN",
            "postal_code": "566492154",
            "telephone_number": "218-283-4481",
            "fax_number": "218-283-2281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "912 MAIN ST UNIT C",
            "city": "LITTLEFORK",
            "state": "MN",
            "postal_code": "566539379",
            "telephone_number": "218-278-2000",
            "fax_number": "218-278-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNATIONAL FALLS MEMORIAL HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-02",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A",
        "authorized_official_last_name": "PASTOR",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "218-283-5488",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "243987",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rainy Lake Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Rainy Lake Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Littlefork, MN

Sources for this page

Verify at the official NPI Registry.