NPIMap

Organization Active NPI

CHI Health Connect at Home-Fargo

Doing business as CHI Health at Home

  • Community Based Hospice Care Agency
  • Dickinson, ND
National Provider Identifier
1578878047
Registry record updated Jan 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
6005 Issued in ND
Legal business name
CHI HEALTH CONNECT AT HOME-FARGO
Doing business as
CHI Health at Home
Practice address
986 2ND Avenue West
Dickinson, ND 58601-3916
Phone
(701) 456-4378
Fax
(701) 456-4809
NPI assigned
Aug 9, 2010
Last updated
Jan 22, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMONSPIRIT HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 22, 2024

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

Authorized official

Name
Nicole Peyerl
Title
Director Operations/Auth Official
Phone
(701) 238-3206

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 6005 ND Primary

Addresses

Primary practice location

986 2ND Avenue West
Dickinson, ND 58601-3916

Mailing address

4265 45TH St S Ste 200
Fargo, ND 58104-4309
Phone (701) 237-8116

Other names 1

  • CHI Health at Home Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101201000195 ND Part A Provider - Hospice 4789870924 Practice locations: Dickinson, ND

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1578878047. Details of each certification follow.

Hospice certification: CCN 351507

Legal name
CHI HEALTH CONNECT AT HOME - FARGO
Doing business as
CHI HEALTH AT HOME
Certification status
Active
Provider type (POS)
Hospice
Participating since
Dec 4, 1991
Last certification
Jun 8, 2022
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 10, 2010 in MN
Enrollment address
986 2ND Ave W
Dickinson, ND 58601-3916

Other NPIs with the same Medicare PAC ID 11

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

Care Compare: Hospice

Medicare Care Compare
Listed as
CHI Health at Home - HospiceCCN 351507 · All quality measures
Ownership
Other
Certified
Dec 4, 1991
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
CHI Health Connect at Home18 organizations share this tax ID, including this one
Part of
Catholic Health Initiatives

Other organizations with this tax ID 17

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

View all 17

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Glenda S Reemts Individual Corporate DirectorBoard Member Oct 1, 2018
Commonspirit Health Organization, Englewood, CO Corporation, Non-profit 5% Or Greater Direct Ownership Interest Dec 26, 2010 100%
Wendy L McGinley Individual Corporate DirectorBoard Member Jul 1, 2019
Laura J Archuleta Individual Contracted Managing EmployeeMD; Sep 1, 2020
Mary P Burger Individual Corporate DirectorBoard Member/Secretary/Treasurer Jul 1, 2014
Nicole a Peyerl Individual Corporate OfficerMarket Vice President of Operations Oct 1, 2021
W-2 Managing EmployeeAd; Oct 1, 2021
Douglas a Harildstad Individual Corporate DirectorBoard Member, Vice Chairperson Jul 1, 2011
Kevin E Lofton Individual Operational/Managerial ControlChain Home Office Administrator Dec 26, 2010
Gretchen K Dobervich Individual Corporate DirectorBoard Member Jan 1, 2018
Chad D Peterson Individual Corporate DirectorBoard Member/Chairperson Jul 1, 2014
Lance W Gulleson Individual Corporate DirectorBoard Member Jul 1, 2018
Karen B Fixen-Bercier Individual W-2 Managing EmployeeDirector Operations Jul 13, 2023
Gloria a Dohman Individual Corporate DirectorBoard Member Jul 1, 2017
Jeffrey Drop Individual Corporate DirectorBoard Member Dec 26, 2010

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 7

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

NPI Registry JSON

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

{
    "created_epoch": "1281312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705881600000",
    "number": "1578878047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4265 45TH ST S STE 200",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581044309",
            "telephone_number": "701-237-8116",
            "fax_number": "701-237-8188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "986 2ND AVENUE WEST",
            "city": "DICKINSON",
            "state": "ND",
            "postal_code": "586013916",
            "telephone_number": "701-456-4378",
            "fax_number": "701-456-4809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHI HEALTH CONNECT AT HOME-FARGO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMONSPIRIT HEALTH",
        "enumeration_date": "2010-08-09",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A",
        "authorized_official_last_name": "PEYERL",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "DIRECTOR OPERATIONS/AUTH OFFICIAL",
        "authorized_official_telephone_number": "701-238-3206"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "ND",
            "license": "6005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHI Health at Home",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CHI Health at Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dickinson, ND

Sources for this page

Verify at the official NPI Registry.