NPIMap

Organization Active NPI

Riverview Healthcare Association

Doing business as RiverView Rehab Services Fertile

  • Physical Therapy Clinic/Center
  • Fertile, MN
National Provider Identifier
1659045987
Registry record updated Aug 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
RIVERVIEW HEALTHCARE ASSOCIATION
Doing business as
RiverView Rehab Services Fertile
Practice address
101 S Mill St
Fertile, MN 56540-4300
Phone
(218) 945-6695
NPI assigned
Aug 2, 2021
Last updated
Aug 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2021

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

Authorized official

Name
Kari Moe
Title
Credentialing Specialist
Phone
(218) 281-9293

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X NU Primary

Addresses

Primary practice location

101 S Mill St
Fertile, MN 56540-4300

Mailing address

323 S Minnesota St
Crookston, MN 56716-1601
Phone (218) 281-9200

Other names 1

  • RiverView Rehab Services Fertile Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040128000040 MN Part B Supplier - Clinic/Group Practice 7810806718 Receives reassigned benefits from 69 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Thief River Falls, MN; Red Lake Falls, MN; East Grand Forks, MN; Crookston, MN; Fertile, MN
O20060505000925 MN Part A Provider - Critical Access Hospital 7810806718 Receives reassigned benefits from 62 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fertile, MN; Thief River Falls, MN; Red Lake Falls, MN; Crookston, MN; East Grand Forks, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1659045987. Details of each certification follow.

Hospital certification: CCN 241320

Legal name
RIVERVIEW HEALTHCARE ASSOCIATION
Doing business as
RIVERVIEW HEALTH
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Nov 1, 2001
Last certification
Aug 17, 2010
Beds
49 (25 certified)
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jun 14, 1898 in MN
Enrollment address
323 S Minnesota St
Crookston, MN 56716-1601

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

Other NPIs on the same Medicare enrollment 7

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Riverview HospitalCCN 241320 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Riverview Clinic12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

105 International Dr
Ste 25
Red Lake Falls, MN 56750
Phone (218) 253-4606

311 Broadway Ave NE
Red Lake Falls, MN 56750
Phone (218) 253-2157

3001 Sanford Pkwy
Thief Rvr Fls, MN 56701
Phone (218) 681-4240

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Lori Keller Individual Corporate DirectorBoard Member Jul 30, 2020
Christopher Patrick Bruggeman Individual Corporate OfficerC.O.O. Sep 1, 2007
W-2 Managing EmployeeAd; Sep 1, 2007
Erik J Kanten Individual Corporate DirectorBoard Member Jan 28, 2019
W-2 Managing EmployeeBoard Memeber Jan 28, 2019
Judy Hulst Individual Corporate DirectorBoard Member Jan 1, 2025
Brett K Vibeto Individual Corporate DirectorBoard Member Oct 31, 2019
W-2 Managing EmployeeBoard Memeber Oct 31, 2019
Tim James Brinkman Individual Corporate DirectorBoard Member Jan 22, 2018
Carrie a Michalski Individual Corporate OfficerC.E.O. Jan 1, 2012
W-2 Managing EmployeeAd; Jan 1, 2012
Kari Koenig Individual Corporate DirectorBoard Member Jan 28, 2019
Nicole Heldstab Individual Corporate DirectorBoard Member Jan 1, 2025
Andrew S Oman Individual Corporate DirectorBoard Member Jan 26, 2026
Michelle M Fairman Cote Individual Corporate DirectorBoard Member Jan 1, 2025
Tanner Holten Individual Corporate DirectorBoard Member Jan 1, 2025

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 63

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 63

Affiliated clinicians 137

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 137

NPI Registry JSON

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

{
    "created_epoch": "1627862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627862400000",
    "number": "1659045987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "323 S MINNESOTA ST",
            "city": "CROOKSTON",
            "state": "MN",
            "postal_code": "567161601",
            "telephone_number": "218-281-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 S MILL ST",
            "city": "FERTILE",
            "state": "MN",
            "postal_code": "565404300",
            "telephone_number": "218-945-6695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERVIEW HEALTHCARE ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-02",
        "last_updated": "2021-08-02",
        "certification_date": "2021-06-16",
        "status": "A",
        "authorized_official_last_name": "MOE",
        "authorized_official_first_name": "KARI",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "218-281-9293"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RiverView Rehab Services Fertile",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fertile, MN

Sources for this page

Verify at the official NPI Registry.