NPIMap

Organization Active NPI

Good Samaritan Hospital Association

  • Family Medicine Physician
  • Rugby, ND
National Provider Identifier
1578734869
Registry record updated Oct 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GOOD SAMARITAN HOSPITAL ASSOCIATION
Practice address
2975 Highway 2 E
Ste 100
Rugby, ND 58368-7801
Phone
(701) 776-5235
NPI assigned
Mar 14, 2008
Organization subpart
Yes
Parent organization
GOOD SAMARITAN HOSPITAL ASSOCIATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 2, 2024

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

Authorized official

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

Specialties & licenses 2

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

Addresses

Primary practice location

2975 Highway 2 E
Ste 100
Rugby, ND 58368-7801

Mailing address

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

Other practice location 1

800 S Main Ave
Rugby, ND 58368-2118
Phone (701) 776-5261

Other identifiers 1

IdentifierTypeStateIssuer
1457110MedicaidND

Other names 1

  • Heart of America Johnson Clinic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101109000476 ND Part A Provider - Rural Health Clinic 6002716701 1 other NPI on this enrollment
Practice locations: Rugby, ND

Rural health clinic certification: CCN 353450

Legal name
GOOD SAMARITAN HOSPITAL ASSOCIATION
Doing business as
HEART OF AMERICA JOHNSON CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 15, 1996
Last certification
Feb 14, 2024
Ownership / control type
2B
Most recent change of ownership
Aug 1, 2010 (1 total)
Organization structure
CorporationNon-profit
Enrollment address
2975 Highway 2 E
Ste 100
Rugby, ND 58368-7801
Related CCNs
351332

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

Other NPIs with the same Medicare PAC ID 7

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.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
35D1035575Heart of America Johnson Clinic Rugby2975 Highway 2 East, Rugby, ND 58368Certificate of waiverJan 4, 2027

National Provider Directory

National Provider Directory
Tax ID family
Rugby Ambulance8 organizations share this tax ID, including this one
Part of
Rugby Ambulance

Other organizations with this tax ID 7

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

Locations

2975 Highway 2 E
Ste 100
Rugby, ND 58368
Phone (701) 776-5235

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
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 ControlMedical Director Mar 9, 2023
Craig Zachmeier Individual Corporate Director Nov 12, 2019
Kimberley Bott Individual Corporate Director Feb 25, 2021
Christine Jaeger Individual Corporate DirectorBoard Member 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 OfficerCeo Apr 13, 2020
W-2 Managing EmployeeCeo Apr 13, 2020
Operational/Managerial ControlCeo Apr 13, 2020
Melissa Shepard Individual Corporate OfficerCfo Aug 1, 2019
W-2 Managing EmployeeCfo Aug 1, 2019
Operational/Managerial ControlCfo Aug 1, 2019
Jesse Fahnestock Individual Corporate DirectorBoard Member Aug 18, 2025
Dustin T Hager Individual W-2 Managing EmployeeAd;Clinic Director Sep 28, 2005
Operational/Managerial ControlClinic Director Sep 28, 2005
Lisa Thorp Individual Corporate Director Nov 21, 2022

Owners & managing parties with NPI records 2

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

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

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1205452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727827200000",
    "number": "1578734869",
    "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": "2975 HIGHWAY 2 E",
            "address_2": "STE 100",
            "city": "RUGBY",
            "state": "ND",
            "postal_code": "583687801",
            "telephone_number": "701-776-5235"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 S Main Ave",
            "address_purpose": "LOCATION",
            "city": "Rugby",
            "state": "ND",
            "postal_code": "583682118",
            "country_code": "US",
            "telephone_number": "701-776-5261",
            "fax_number": "701-776-5448",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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": "1457110",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heart of America Johnson Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Heart of America Johnson Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Rugby, ND

Sources for this page

Verify at the official NPI Registry.