NPIMap

Good Samaritan Hospital Association

Organization Active NPI Family Medicine Physician · Dunseith, ND

NPI 1568633865 · NPPES record last updated Oct 2, 2024

Key facts

NPI
1568633865
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
GOOD SAMARITAN HOSPITAL ASSOCIATION
Practice address
215 Main St SE
Dunseith, ND 58329
Phone
(701) 224-5694
Fax
(701) 244-5329
NPI assigned
Mar 14, 2008
Organization subpart
Yes
Parent organization (as reported)
GOOD SAMARITAN HOSPITAL ASSOCIATION

Authorized official

Name
Erik T Christenson
Title
Ceo
Phone
(701) 776-5261

Owners & managing parties with NPI records 2

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

Owned or controlled facilities with NPI records 2

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

Other NPIs with the same Medicare PAC ID 7

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

Corporate family (same tax ID) 7

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

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

Practitioners 25

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

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
35D0667044Heart of America Johnson Clinic Dunseith
215 Main St SE, Dunseith, ND 58329		Certificate of waiverJul 28, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in ND

Rural health clinic certification: CCN 353451

Legal name
GOOD SAMARITAN HOSPITAL ASSOCIATION
Doing business as
HEART OF AMERICA JOHNSON CLINIC DUNSEITH
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 16, 1991
Last certification
Feb 13, 2019
Ownership / control type
2B
Most recent change of ownership
Aug 1, 2010 (1 total)
Organization structure
Corporation · Non-profit
Incorporated
Apr 11, 1905 in ND
Enrollment address
215 Main St SE
Dunseith, ND 58329-2934
Related CCNs
351332

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
Richard D Anderson
Individual 		Corporate Director Nov 17, 2025
Tanner Lee Johnson
Individual 		Corporate Director Oct 18, 2021
Josalynne L Hoff Rue
Individual 		W-2 Managing Employee Mar 9, 2023
Operational/Managerial Control
Medical Director		 Mar 9, 2023
Craig Zachmeier
Individual 		Corporate Director Nov 12, 2019
Kimberley Bott
Individual 		Corporate Director Feb 25, 2021
Christine Jaeger
Individual 		Corporate Director Nov 17, 2025
Michael Graner
Individual 		Corporate Officer Aug 1, 2022
Corporate Director Apr 14, 2021
Wayne Trottier
Individual 		Corporate Officer Aug 1, 2022
Corporate Director Nov 12, 2019
Erik Christenson
Individual 		Corporate Officer
Ceo		 Apr 13, 2020
W-2 Managing Employee
Ceo		 Apr 13, 2020
Operational/Managerial Control
Ceo		 Apr 13, 2020
Melissa Shepard
Individual 		Corporate Officer
Cfo		 Aug 1, 2019
W-2 Managing Employee
Cfo		 Aug 1, 2019
Operational/Managerial Control
Cfo		 Aug 1, 2019
Jesse Fahnestock
Individual 		Corporate Officer Aug 18, 2025
Dustin T Hager
Individual 		W-2 Managing Employee
Ad;Clinic Director		 Sep 28, 2005
Operational/Managerial Control
Clinic Director		 Sep 28, 2005
Lisa Thorp
Individual 		Corporate Director Nov 21, 2022

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Heart of America Medical Center
Rugby, ND · CCN 351332		 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Heart of America Medical Center
Rugby, ND · CCN 35Z332		 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20101109000753 ND Part a Provider - Rural Health Clinic 6002716701 Practice locations: Dunseith, ND

National Provider Directory

Tax ID family
Rugby Ambulance (8 organizations share this tax ID)
Part of
Rugby Ambulance

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X Yes
Rural Health Clinic/Center 261QR1300X

Addresses

Primary practice location

215 Main St SE
Dunseith, ND 58329

Mailing address

2975 Highway 2 E
Rugby, ND 58368-7801
Phone (701) 776-5455

Other identifiers

IdentifierTypeStateIssuer
1457111MedicaidND

Other names

  • Heart of America Johnson Clinic - Dunseith Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 2, 2024.

{
    "created_epoch": "1205452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727827200000",
    "number": "1568633865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2975 HIGHWAY 2 E",
            "city": "RUGBY",
            "state": "ND",
            "postal_code": "583687801",
            "telephone_number": "701-776-5455",
            "fax_number": "701-776-5448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 MAIN ST SE",
            "city": "DUNSEITH",
            "state": "ND",
            "postal_code": "58329",
            "telephone_number": "701-224-5694",
            "fax_number": "701-244-5329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN HOSPITAL ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GOOD SAMARITAN HOSPITAL ASSOCIATION",
        "enumeration_date": "2008-03-14",
        "last_updated": "2024-10-02",
        "certification_date": "2024-09-30",
        "status": "A",
        "authorized_official_last_name": "CHRISTENSON",
        "authorized_official_first_name": "ERIK",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "701-776-5261"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1457111",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heart of America Johnson Clinic - Dunseith",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Heart of America Johnson Clinic - Dunseith",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Dunseith, ND

All providers in Dunseith, ND · Family Medicine Physician in North Dakota

Sources for this page

Verify at the official NPI Registry.