NPIMap

Organization Active NPI

Lifecare Medical Center

  • Critical Access Hospital
  • Roseau, MN
National Provider Identifier
1609861095
Registry record updated Jun 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
LIFECARE MEDICAL CENTER
Practice address
715 Delmore Dr
Roseau, MN 56751-1534
Phone
(218) 463-2500
Fax
(218) 463-4782
NPI assigned
Sep 13, 2005
Last updated
Jun 10, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2013

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

Authorized official

Name
Catherine A. Huss
Title
Cfo
Phone
(218) 463-4763

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X MN Primary

Addresses

Primary practice location

715 Delmore Dr
Roseau, MN 56751-1534

Mailing address

715 Delmore Dr
Roseau, MN 56751-1534
Phone (218) 463-2500

Other identifiers 3

IdentifierTypeStateIssuer
842724100MedicaidMN
850026600MedicaidMN
342547900MedicaidMN

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040121000061 MN Part B Supplier - Clinic/Group Practice 4789586884 Receives reassigned benefits from 92 practitioners
Practice locations: Roseau, MN
O20061104000664 MN Part A Provider - Critical Access Hospital 4789586884 Receives reassigned benefits from 93 practitioners
Practice locations: Greenbush, MN; Roseau, MN; Warroad, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609861095. Details of each certification follow.

Hospital certification: CCN 241344

Legal name
LIFECARE MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Oct 1, 2002
Last certification
Oct 1, 2002
Beds
15
Ownership / control type
Private (not for profit)
Organization structure
OtherNon-profit
Incorporated
Oct 1, 1995 in MN
Enrollment address
715 Delmore Dr
Roseau, MN 56751-1534
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 8

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Lifecare Medical CenterCCN 241344 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Keith W Okeson Individual Corporate OfficerCeo Jul 31, 2005
W-2 Managing EmployeeCeo Jul 31, 2005
Chuck D Lindner Individual Corporate DirectorBoard Member Sep 1, 2007
Beth L Johnson Individual Corporate DirectorBoard Member Oct 1, 2015
Corwin D Vatnsdal Individual Corporate DirectorBoard Member Oct 1, 2007
Therese a McBride Individual Corporate DirectorBoard Member Aug 1, 1995
Catherine a Huss Individual Corporate OfficerCfo Dec 5, 2000
W-2 Managing EmployeeCfo Dec 5, 2000
Shayne K Isane Individual Corporate DirectorBoard Member Mar 1, 2012
Mark W Wilson Individual Corporate DirectorBoard Member Oct 1, 2009
Ronald W Brummer Individual Corporate DirectorBoard Member Apr 1, 2019
Mark T Karl Individual Corporate DirectorBoard Member Aug 22, 2016
Brenda K Sather Individual Corporate DirectorBoard Member Oct 1, 2009
Dan a Urness Individual Corporate DirectorBoard Member Aug 22, 2016
Jessica R Foss Individual Corporate DirectorBoard Member Oct 1, 2015
Matthew L Ulwelling Individual Corporate DirectorBoard Member Nov 1, 2013
Megan S Comstock Individual Corporate DirectorBoard Member Feb 28, 2022

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

Practitioners 148

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 148

Affiliated clinicians 155

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

View all 155

NPI Registry JSON

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

{
    "created_epoch": "1126569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370822400000",
    "number": "1609861095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 DELMORE DR",
            "city": "ROSEAU",
            "state": "MN",
            "postal_code": "567511534",
            "telephone_number": "218-463-2500",
            "fax_number": "218-463-4782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 DELMORE DR",
            "city": "ROSEAU",
            "state": "MN",
            "postal_code": "567511534",
            "telephone_number": "218-463-2500",
            "fax_number": "218-463-4782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFECARE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-13",
        "last_updated": "2013-06-10",
        "status": "A",
        "authorized_official_last_name": "HUSS",
        "authorized_official_first_name": "CATHERINE",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "218-463-4763"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "842724100",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "850026600",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "342547900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseau, MN

Sources for this page

Verify at the official NPI Registry.