NPIMap

Organization Active NPI

North Dakota State Hospital

  • Psychiatric Hospital
  • Jamestown, ND
National Provider Identifier
1649227075
Registry record updated Dec 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
5060A Issued in ND
Legal business name
NORTH DAKOTA STATE HOSPITAL
Practice address
2605 Circle Dr
Jamestown, ND 58401-6905
Phone
(701) 253-3964
Fax
(701) 253-3999
NPI assigned
May 30, 2006
Last updated
Dec 10, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2020

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

Authorized official

Name
Donna Aukland
Title
Assistant Cfo - DHS
Phone
(701) 328-4924

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X ND
Psychiatric Hospital 283Q00000X 5060A ND Primary

Addresses

Primary practice location

2605 Circle Dr
Jamestown, ND 58401-6905

Mailing address

2605 Circle Dr
Jamestown, ND 58401-6905
Phone (701) 253-3964

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041007000543 ND Part B Supplier - Clinic/Group Practice 5698734374 Receives reassigned benefits from 24 practitioners
Practice locations: Jamestown, ND
O20051011000140 ND Part A Provider - Hospital 5698734374 Practice locations: Jamestown, ND

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649227075. Details of each certification follow.

Hospital certification: CCN 354003

Legal name
NORTH DAKOTA STATE HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Apr 22, 1987
Last certification
Jun 5, 2013
Beds
125
Ownership / control type
State
Organization structure
GovernmentNon-profit
Enrollment address
2605 Circle Dr
Jamestown, ND 58401-6905
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

Care Compare: Hospital

Medicare Care Compare
Listed as
North Dakota State HospitalCCN 354003 · All quality measures
Type
Psychiatric
Ownership
Government - State
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

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
35D0408746North Dakota State Hospital2605 Circle Dr, Jamestown, ND 58401AccreditationJan 2, 2027

National Provider Directory

National Provider Directory
Tax ID family
North Dakota State Hospital3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
North Dakota State Hospital Organization, Jamestown, ND Operational/Managerial Control Jan 1, 1980 100%
Other Jan 1, 1980
Eduardo P Yabut Individual Operational/Managerial ControlMedical Director Mar 1, 2019 100%

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 26

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 26

NPI Registry JSON

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

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607558400000",
    "number": "1649227075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2605 CIRCLE DR",
            "city": "JAMESTOWN",
            "state": "ND",
            "postal_code": "584016905",
            "telephone_number": "701-253-3964",
            "fax_number": "701-253-3999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2605 CIRCLE DR",
            "city": "JAMESTOWN",
            "state": "ND",
            "postal_code": "584016905",
            "telephone_number": "701-253-3964",
            "fax_number": "701-253-3999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH DAKOTA STATE HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-30",
        "last_updated": "2020-12-10",
        "certification_date": "2020-12-10",
        "status": "A",
        "authorized_official_last_name": "AUKLAND",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "ASSISTANT CFO - DHS",
        "authorized_official_telephone_number": "701-328-4924"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "ND",
            "license": null,
            "primary": false
        },
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "ND",
            "license": "5060A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamestown, ND

Sources for this page

Verify at the official NPI Registry.