Nelson County Health System
Organization Active NPI Rural Health Clinic/Center · McVille, ND
NPI 1578624136 · NPPES record last updated May 7, 2014
Key facts
- NPI
- 1578624136
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- NELSON COUNTY HEALTH SYSTEM
- Practice address
- 108 North Main Street
McVille, ND 58254-0307 - Phone
- (701) 322-4347
- Fax
- (701) 322-2244
- NPI assigned
- Dec 13, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Bruce D Bowersox
- Title
- Administrator
- Phone
- (701) 322-4328
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 3
Related certifications (CCN) 1
Practitioners 10
-
Michael L Hammer, DNP
-
Stephanie Slivnik, DNP, FNP-BC
-
Jonathon H Berg, MD
-
Darlene C Kelly, ARNP
-
Buck Bania, MD
-
Christina Nicole Brooks, PA-C
-
Beverly Ann Swenson Gibson, MSN, APRN, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ND
Rural health clinic certification: CCN 353977
- Legal name
- NELSON COUNTY HEALTH SYSTEM
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Dec 6, 1990
- Last certification
- Jan 29, 2020
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 26, 1947 in ND
- Enrollment address
- 108 N Main St
McVille, ND 58254-4203 - Related CCNs
- 350779
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Samantha Harding |
W-2 Managing Employee | Jan 1, 2022 | |
| Steven K Forde |
W-2 Managing Employee |
Jan 1, 2022 | |
| Brandon Lundeby |
Corporate Director |
Nov 4, 2012 | |
| Nancy Charles |
Corporate Officer | Jan 1, 2021 | |
| Brandon Jensen |
Corporate Director |
Nov 7, 2013 | |
| Amie Vasichek |
Corporate Officer | Jan 1, 2022 | |
| Tanya Swenson |
Corporate Officer | Jan 1, 2022 | |
| Ivan Berg |
Corporate Director |
Nov 6, 2011 | |
| Doris Forde |
Corporate Officer | Jan 1, 2020 | |
| Delores Lillehaugen |
Corporate Officer | Jan 1, 2018 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Nelson County Health System |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2010 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040206000390 | ND | Part B Supplier - Clinic/Group Practice | 5597658104 |
Receives reassigned benefits from 10 practitioners 1 other NPI on this enrollment Practice locations: Michigan, ND; McVille, ND |
| O20050427000698 | ND | Part a Provider - Rural Health Clinic | 5597658104 | Practice locations: McVille, ND |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | ND | Yes |
Addresses
Primary practice location
108 North Main Street
McVille, ND 58254-0307
Mailing address
PO Box 307
McVille, ND 58254-0307
Phone (701) 322-4347
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 016279 | Medicaid | ND | |
| 005005 | Medicaid | ND | |
| 004572 | Other | ND | RURAL HEALTH CLINIC |
| 301001 | Other | ND | BLUE CROSS BLUE SHIELD |
Other providers in McVille, ND
- Michael L Hammer
- Darlene C Kelly
- Erling D Martinson
- McVille Community Ambulance Services
- Nelson County Health System
- Nelson County Health System
- Nelson County Health System
- Nelson County Health System
- Nelson County Health System
- Nelson-Griggs District Health Unit
All providers in McVille, ND · Rural Health Clinic/Center in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 7, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.