NPIMap

Organization Active NPI

Glacial Ridge Hospital District

Doing business as Glenwood Medical Center

  • Family Medicine Physician
  • Glenwood, MN
National Provider Identifier
1649285172
Registry record updated Aug 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GLACIAL RIDGE HOSPITAL DISTRICT
Doing business as
Glenwood Medical Center
Practice address
417 Franklin St S
Glenwood, MN 56334-1518
Phone
(320) 634-4521
Fax
(320) 634-2262
NPI assigned
Jul 31, 2006
Last updated
Aug 23, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2010

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

Authorized official

Name
Kirk Stensrud
Title
Ceo
Phone
(320) 634-2208

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

417 Franklin St S
Glenwood, MN 56334-1518

Mailing address

417 Franklin St S
Glenwood, MN 56334-1518
Phone (320) 634-4521

Other names 1

  • GLENWOOD MEDICAL CENTER Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050719000315 MN Part B Supplier - Clinic/Group Practice 5294789194 Receives reassigned benefits from 125 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Starbuck, MN; Glenwood, MN; Brooten, MN
O20050812000875 MN Part A Provider - Rural Health Clinic 5294789194 Practice locations: Belgrade, MN; Brooten, MN; Glenwood, MN; Kensington, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649285172. Details of each certification follow.

Rural health clinic certification: CCN 243437

Legal name
GLACIAL RIDGE HOSPITAL DISTRICT
Doing business as
GLACIAL RIDGE HEALTH SYSTEM
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 1, 2005
Last certification
Sep 18, 2012
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1976 in MN
Enrollment address
10 4TH Ave SE
Glenwood, MN 56334-1820
Related CCNs
243437

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
24D1045412Glenwood Medical Center417 South Franklin, Glenwood, MN 56334Certificate of waiverSep 13, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Kirk a Stensrud Individual W-2 Managing Employee Jun 24, 2005

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Glacial Ridge HomecareGlenwood, MN, CCN 247212 Home health agency 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Mar 19, 2010
Mar 19, 2010
Glacial Ridge HospiceGlenwood, MN, CCN 241502 Hospice 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Mar 4, 1993
Aug 1, 2000

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 30

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 30

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282521600000",
    "number": "1649285172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 FRANKLIN ST S",
            "city": "GLENWOOD",
            "state": "MN",
            "postal_code": "563341518",
            "telephone_number": "320-634-4521",
            "fax_number": "320-634-2262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 FRANKLIN ST S",
            "city": "GLENWOOD",
            "state": "MN",
            "postal_code": "563341518",
            "telephone_number": "320-634-4521",
            "fax_number": "320-634-2262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLACIAL RIDGE HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-31",
        "last_updated": "2010-08-23",
        "status": "A",
        "authorized_official_last_name": "STENSRUD",
        "authorized_official_first_name": "KIRK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "320-634-2208"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GLENWOOD MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glenwood, MN

Sources for this page

Verify at the official NPI Registry.