NPIMap

Organization Active NPI

Presentation Medical Center

  • Medicare Defined Swing Bed Hospital Unit
  • Rolla, ND
National Provider Identifier
1619033917
Registry record updated Aug 22, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
5045A Issued in ND
Legal business name
PRESENTATION MEDICAL CENTER
Practice address
213 2ND Ave NE
Rolla, ND 58367-0759
Phone
(701) 477-3161
Fax
(701) 477-5564
NPI assigned
Dec 29, 2006
Last updated
Aug 22, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2007

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

Authorized official

Name
Ms. Paula J Wilkie
Title
Chief Financial Officer
Phone
(701) 477-3161

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 5045A ND Primary

Addresses

Primary practice location

213 2ND Ave NE
Rolla, ND 58367-0759

Mailing address

PO Box 759
Rolla, ND 58367-0759
Phone (701) 477-3161

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101029001368 ND Part A Provider - Critical Access Hospital 5991764045 Practice locations: Rolla, ND

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619033917. Details of each certification follow.

Hospital certification: CCN 35Z316

Legal name
PRESENTATION MEDICAL CENTER
Doing business as
SMP HEALTH - ST. KATERI
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1939 in ND
Enrollment address
213 2ND Ave NE
Rolla, ND 58367-7153
Hospital Swing-Bed Unit

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

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Presentation Medical5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Lori Martinson Individual W-2 Managing EmployeeDon May 1, 2016
Presentation Medical Center Organization, Rolla, ND Corporation, Non-profit Operational/Managerial Control Jul 1, 2021
Shelley Counts Individual Operational/Managerial Control Jul 1, 2021
Derrik Dixon Individual Contracted Managing Employee Jul 1, 2021
Paula Wilkie Individual Contracted Managing EmployeeCfo Jan 1, 2003
Corporate Director Jul 23, 2010
Operational/Managerial ControlCfo Jan 1, 2003
Brian Grosinger Individual Corporate Director Jul 1, 2023
Debra Berry Individual Corporate Director Jun 1, 2000
Christopher Albertson Individual Corporate OfficerCeo Oct 1, 2017

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 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
SMP Health - St. KateriRolla, ND, CCN 351316 Hospital Operational/Managerial Control Jan 1, 1973

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 52

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 52

Affiliated clinicians 1

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": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187740800000",
    "number": "1619033917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 759",
            "city": "ROLLA",
            "state": "ND",
            "postal_code": "583670759",
            "telephone_number": "701-477-3161",
            "fax_number": "701-477-5564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 2ND AVE NE",
            "city": "ROLLA",
            "state": "ND",
            "postal_code": "583670759",
            "telephone_number": "701-477-3161",
            "fax_number": "701-477-5564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESENTATION MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2007-08-22",
        "status": "A",
        "authorized_official_last_name": "WILKIE",
        "authorized_official_first_name": "PAULA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "701-477-3161",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "ND",
            "license": "5045A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rolla, ND

Sources for this page

Verify at the official NPI Registry.