NPIMap

Organization Active NPI

Mercy Hospital of Devils Lake

  • Medicare Defined Swing Bed Hospital Unit
  • Devils Lake, ND
National Provider Identifier
1609972884
Registry record updated Sep 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
5012A Issued in ND
Legal business name
MERCY HOSPITAL OF DEVILS LAKE
Practice address
1031 7TH Street NE
Devils Lake, ND 58301-2798
Phone
(701) 662-2131
Fax
(701) 662-9651
NPI assigned
Sep 15, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Kurt Sargent
Title
VP Operational Finance
Phone
(701) 237-8064

Owners & managing parties with NPI records 1

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

Other NPIs with the same Medicare PAC ID 2

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

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

Practitioners 12

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

Affiliated clinicians 5

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070521000499 ND Part a Provider - Critical Access Hospital 9537128681 Receives reassigned benefits from 1 practitioner
Practice locations: Devils Lake, ND

Hospital certification: CCN 35Z333

Medicare enrollment files
Legal name
MERCY HOSPITAL OF DEVILS LAKE
Doing business as
CHI ST ALEXIUS HEALTH DEVILS LAKE
Organization structure
CorporationNon-profit
Incorporated
May 8, 1894 in ND
Enrollment address
1031 7TH St NE
Devils Lake, ND 58301-2719
Main/Primary Hospital Location

All disclosed owners & managing parties 10

Medicare enrollment files

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

NameRoleSinceShare
Commonspirit Health Organization, Chicago, IL Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 1996 100%
Corry Kenner Individual Corporate OfficerChair Jan 1, 2020
Corporate DirectorChair Jan 1, 2020
Daniel Morissette Individual OtherCfo, Commonspirit Health Feb 1, 2019
Mariann K Doeling Individual Corporate OfficerPresident Mar 1, 2023
Corporate DirectorPresident Mar 1, 2023
Julie Traynor Individual Corporate Director Oct 1, 2018
Amber G Stowman Individual Corporate OfficerMKT VP Operational Finance Mar 1, 2021
Operational/Managerial ControlMKT VP Operational Finance Mar 1, 2021
Tessa Marburger Individual Corporate Director Oct 26, 2016
Melissa Huhn Individual Corporate DirectorBoard Member Jan 1, 2020
Taylor Grundstad Individual Corporate OfficerSecretary, Treasurer Jul 1, 2021
Corporate DirectorSecretary, Treasurer Jul 1, 2021
Lisa Kostelecky Individual Corporate DirectorBoard Member Jul 1, 2021

National Provider Directory

National Provider Directory
Tax ID family
Mercy Hospital2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

3290 Solutions Ctr
Chicago, IL 60677

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 5012A ND Primary

Addresses

NPPES NPI Registry

Primary practice location

1031 7TH Street NE
Devils Lake, ND 58301-2798

Mailing address

1031 7TH Street NE
Devils Lake, ND 58301-2798
Phone (701) 662-2131

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
4291OtherNDBLUE CROSS SWING BED
01939MedicaidND

Other names 1

NPPES NPI Registry
  • CHI St Alexius Health Devils Lake Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 17, 2016.

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474070400000",
    "number": "1609972884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1031 7TH STREET NE",
            "city": "DEVILS LAKE",
            "state": "ND",
            "postal_code": "583012798",
            "telephone_number": "701-662-2131",
            "fax_number": "701-662-9651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1031 7TH STREET NE",
            "city": "DEVILS LAKE",
            "state": "ND",
            "postal_code": "583012798",
            "telephone_number": "701-662-2131",
            "fax_number": "701-662-9651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HOSPITAL OF DEVILS LAKE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2016-09-17",
        "status": "A",
        "authorized_official_last_name": "SARGENT",
        "authorized_official_first_name": "KURT",
        "authorized_official_title_or_position": "VP OPERATIONAL FINANCE",
        "authorized_official_telephone_number": "701-237-8064"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "ND",
            "license": "5012A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS SWING BED",
            "identifier": "4291",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01939",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHI St Alexius Health Devils Lake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Devils Lake, ND

Sources for this page

Verify at the official NPI Registry.