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Organization Active NPI

Glacial Ridge Hospital District

Doing business as Glacial Ridge Hospital District - Swing Bed

  • Medicare Defined Swing Bed Hospital Unit
  • Glenwood, MN
National Provider Identifier
1649319146
Registry record updated Aug 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
GLACIAL RIDGE HOSPITAL DISTRICT
Doing business as
Glacial Ridge Hospital District - Swing Bed
Practice address
10 4TH Ave SE
Glenwood, MN 56334-1820
Phone
(320) 634-4521
Fax
(320) 634-2262
NPI assigned
Feb 5, 2007
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
Medicare Defined Swing Bed Hospital Unit 275N00000X MN Primary

Addresses

Primary practice location

10 4TH Ave SE
Glenwood, MN 56334-1820

Mailing address

10 4TH Ave SE
Glenwood, MN 56334-1820
Phone (320) 634-4521

Other names 1

  • GLACIAL RIDGE HOSPITAL DISTRICT - SWING BED Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080430000362 MN Part A Provider - Critical Access Hospital 5294789194 Receives reassigned benefits from 2 practitioners
Practice locations: Glenwood, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649319146. Details of each certification follow.

Hospital certification: CCN 24Z376

Legal name
GLACIAL RIDGE HOSPITAL DISTRICT
Doing business as
GLACIAL RIDGE HOSPITAL
Organization structure
CorporationProprietary
Incorporated
Oct 1, 1976 in MN
Enrollment address
10 Fourth Ave SE
Glenwood, MN 56334-1820
Hospital Swing-Bed Unit

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

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Glacial Ridge Hospital7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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
Kirk a Stensrud Individual Corporate Director Jan 20, 2006
W-2 Managing EmployeeCeo/Administrator Jan 20, 2006
Kyle Chase Individual Corporate Director Aug 1, 2010
W-2 Managing Employee Aug 1, 2010

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 3

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.

Affiliated clinicians 5

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": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282521600000",
    "number": "1649319146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 4TH AVE SE",
            "city": "GLENWOOD",
            "state": "MN",
            "postal_code": "563341820",
            "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": "10 4TH AVE SE",
            "city": "GLENWOOD",
            "state": "MN",
            "postal_code": "563341820",
            "telephone_number": "320-634-4521",
            "fax_number": "320-634-2262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLACIAL RIDGE HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "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": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GLACIAL RIDGE HOSPITAL DISTRICT - SWING BED",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glenwood, MN

Sources for this page

Verify at the official NPI Registry.