NPIMap

Organization Active NPI

Presbyterian Homes Mill Pond Inc

Doing business as Mill Pond

  • Nursing Facility/Intermediate Care Facility
  • Ankeny, IA
National Provider Identifier
1619080462
Registry record updated Nov 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
770477 Issued in IA
Legal business name
PRESBYTERIAN HOMES MILL POND INC
Doing business as
Mill Pond
Practice address
1201 SE Mill Pond Court
Ankeny, IA 50021-6534
Phone
(515) 964-2273
Fax
(515) 965-3100
NPI assigned
Aug 16, 2006
Last updated
Nov 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2025

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

Authorized official

Name
Mark T Meyers
Title
Cfo
Phone
(651) 631-6102

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 770477 IA Primary

Addresses

Primary practice location

1201 SE Mill Pond Court
Ankeny, IA 50021-6534

Mailing address

2845 Hamline Ave N
Roseville, MN 55113-7127
Phone (651) 631-6432

Other identifiers 1

IdentifierTypeStateIssuer
0809145MedicaidIA

Other names 1

  • Mill Pond Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20021021000028 IA Part A Provider - Skilled Nursing Facility 7113835760 Practice locations: Ankeny, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619080462. Details of each certification follow.

Skilled nursing facility certification: CCN 165261

Legal name
PRESBYTERIAN HOMES MILL POND INC
Doing business as
MILL POND
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 19, 1995
Last certification
Mar 6, 2025
Beds
60
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Presbyterian Homes & Services
Organization structure
CorporationNon-profit
Incorporated
Dec 31, 1997 in MN
Enrollment address
1201 SE Mill Pond CT
Ankeny, IA 50021-6534
Nursing home name
MILL-POND
Affiliated entity
PRESBYTERIAN HOMES & SERVICES

Care Compare: Nursing home

Medicare Care Compare
Listed as
Mill-PondCCN 165261 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Sep 19, 1995
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6055.3 residents per day on average
Chain
Presbyterian Homes & Services21 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

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
16D0901361Mill Pond Retirement Home1201 SE Mill Pond Court, Ankeny, IA 50021Certificate of waiverMay 22, 2027

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Katherine S Burns Individual Operational/Managerial Control Oct 1, 2023
Adp of the SNF Oct 1, 2023
Mark T Meyer Individual Operational/Managerial Control Mar 11, 2011
Adp of the SNF Mar 11, 2011
Mark a Pederson Individual Corporate DirectorDirector Jan 1, 2023 33%
First Interstate Bank Organization, Billings, MT Corporation, Financial institution, For-profit 5% Or Greater Mortgage Interest Feb 1, 2022 75%
5% Or Greater Security Interest Feb 1, 2022 75%
Jesica J Culp Individual Operational/Managerial Control Oct 6, 2025
Adp of the SNF Oct 6, 2025
Jonathan David Fletcher Individual Corporate OfficerPresident & Ceo Feb 1, 2025 50%
Corporate DirectorGovernor Feb 1, 2025 33%
Operational/Managerial Control Feb 1, 2025
Adp of the SNF Feb 1, 2025
PHS Management, LLC Organization, Roseville, MN LLC, Management services company, Non-profit, Chain home office Operational/Managerial Control Mar 11, 2011 100%
Adp of the SNF Oct 21, 2025
Heidi a Peterson Individual Corporate OfficerCfo Dec 1, 2025 50%
Corporate DirectorDirector Jan 1, 2023 33%
Operational/Managerial Control Jan 1, 2023
Adp of the SNF Jan 1, 2023
Presbyterian Homes and Services Organization, Roseville, MN Corporation, Non-profit 5% Or Greater Direct Ownership Interest Mar 11, 2011 100%

Owners & managing parties with NPI records 2

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

Facilities with the same owner 22

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

View all 22

Practitioners & affiliated clinicians

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": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762819200000",
    "number": "1619080462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2845 HAMLINE AVE N",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551137127",
            "telephone_number": "651-631-6432",
            "fax_number": "651-631-6122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 SE MILL POND COURT",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500216534",
            "telephone_number": "515-964-2273",
            "fax_number": "515-965-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN HOMES MILL POND INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2025-11-11",
        "certification_date": "2025-11-11",
        "status": "A",
        "authorized_official_last_name": "MEYERS",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "651-631-6102"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "IA",
            "license": "770477",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0809145",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mill Pond",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ankeny, IA

Sources for this page

Verify at the official NPI Registry.