NPIMap

Organization Active NPI

Glencoe Regional Health Services

  • Critical Access Hospital
  • Glencoe, MN
National Provider Identifier
1508885633
Registry record updated Feb 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
GLENCOE REGIONAL HEALTH SERVICES
Doing business as
Glencoe Regional Health Services
Practice address
1805 Hennepin Ave N
Glencoe, MN 55336-1416
Phone
(320) 864-7716
Fax
(320) 864-7186
NPI assigned
Jul 19, 2006
Last updated
Feb 25, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2019

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

Authorized official

Name
Julie Leske
Title
Credentialing Coordinator
Phone
(320) 864-7994

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X NU Primary
Pharmacy 333600000X NU
Institutional Pharmacy 3336I0012X 201001 MN

Addresses

Primary practice location

1805 Hennepin Ave N
Glencoe, MN 55336-1416

Mailing address

1805 Hennepin Ave N
Glencoe, MN 55336-1416
Phone (320) 864-7716

Other identifiers 2

IdentifierTypeStateIssuer
909545400MedicaidMN
2144023OtherPK

Other names 1

  • Glencoe Regional Health Services Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031119000252 MN Part B Supplier - Clinic/Group Practice 1759292980 Receives reassigned benefits from 114 practitioners
Practice locations: Glencoe, MN; Lester Prairie, MN; Stewart, MN
O20060504000699 MN Part A Provider - Critical Access Hospital 1759292980 Receives reassigned benefits from 114 practitioners
Practice locations: Glencoe, MN; Lester Prairie, MN; Stewart, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508885633. Details of each certification follow.

Hospital certification: CCN 241355

Legal name
GLENCOE REGIONAL HEALTH SERVICES
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Sep 1, 2004
Last certification
Aug 30, 2018
Beds
49 (25 certified)
Ownership / control type
Other
Organization structure
OtherNon-profit
Incorporated
Aug 22, 1999 in MN
Enrollment address
1805 Hennepin N Ave
Glencoe, MN 55336-1416
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Glencoe Regional HealthCCN 241355 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Other
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

300 Bowman St
Stewart, MN 55385
Phone (320) 562-2558

Ownership & related parties

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.

NameRoleSinceShare
Angela Erickson Individual W-2 Managing EmployeeChief Financial Officer Feb 9, 2019
Bryan T Petersen Individual OtherBoard Member Jan 1, 2017
Kristine L Knudten Individual OtherBoard Member Jan 1, 2012
Benjamin Davis Individual Corporate OfficerPresident & Ceo May 15, 2023
W-2 Managing EmployeePresident & Ceo May 15, 2023
Kristen L Budahn Individual Other Jan 1, 2024
Jill M Hatlestad Individual W-2 Managing Employee Nov 16, 2007
Heather Peirce Individual Other Jan 1, 2021
Julie a Schmidt Individual W-2 Managing Employee Nov 16, 2007
Sean David Tritabaugh Individual Other Jan 1, 2024
Scott Kuehn Individual OtherBoard Member Jan 1, 2017
Mary K Stoltenburg Individual Other Jan 1, 2018
Lynn Kathryn Beranek Individual W-2 Managing EmployeeVP of Marketing Sep 4, 2023
Bryan J Fritsch Individual OtherBoard Member Jan 1, 2016

Owners & managing parties with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 116

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 116

Affiliated clinicians 121

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

View all 121

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551052800000",
    "number": "1508885633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 HENNEPIN AVE N",
            "city": "GLENCOE",
            "state": "MN",
            "postal_code": "553361416",
            "telephone_number": "320-864-7716",
            "fax_number": "320-864-7186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 HENNEPIN AVE N",
            "city": "GLENCOE",
            "state": "MN",
            "postal_code": "553361416",
            "telephone_number": "320-864-7716",
            "fax_number": "320-864-7186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENCOE REGIONAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2019-02-25",
        "status": "A",
        "authorized_official_last_name": "LESKE",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "320-864-7994"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "MN",
            "license": "201001",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "909545400",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2144023",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glencoe Regional Health Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Glencoe Regional Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glencoe, MN

Sources for this page

Verify at the official NPI Registry.