NPIMap

Organization Active NPI

Grand Itasca Clinic and Hospital

  • General Acute Care Hospital
  • Grand Rapids, MN
National Provider Identifier
1669426631
Registry record updated Feb 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
330789 Issued in MN
Legal business name
GRAND ITASCA CLINIC AND HOSPITAL
Practice address
1601 Golf Course Rd
Grand Rapids, MN 55744-8648
Phone
(218) 326-3401
Fax
(218) 999-1461
NPI assigned
May 22, 2006
Last updated
Feb 14, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2025

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

Authorized official

Name
Todd Christensen
Title
VP of Finance
Phone
(218) 999-1702

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Rehabilitation Hospital Unit 273Y00000X MN
Medicare Defined Swing Bed Hospital Unit 275N00000X
General Acute Care Hospital 282N00000X 330789 MN Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

1601 Golf Course Rd
Grand Rapids, MN 55744-8648

Mailing address

1700 University Ave W
Saint Paul, MN 55104-3727
Phone (612) 672-6740

Other identifiers 1

IdentifierTypeStateIssuer
038345700MedicaidMN

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030902000012 MN Part A Provider - Hospital 8123939550 Practice locations: Grand Rapids, MN
O20031105000209 MN Part B Supplier - Clinic/Group Practice 8123939550 Receives reassigned benefits from 574 practitioners
1 other NPI on this enrollment
Practice locations: Grand Rapids, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669426631. Details of each certification follow.

Hospital certification: CCN 240064A

Legal name
GRAND ITASCA CLINIC AND HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Feb 13, 1997 in MN
Enrollment address
1601 Golf Course Rd
Grand Rapids, MN 55744-8648
Main/Primary Hospital Location
Hospital subgroups
General

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Grand Itasca Clinic and HospitalCCN 240064
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address. The facility is not in the current Medicare enrollment files, which can mean its Medicare enrollment has ended (or, for VA and military hospitals, that it does not enroll).

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Kirk Adams Individual Corporate DirectorBoard of Director Jan 1, 2025
Michael Miskovich Individual Corporate DirectorBoard of Director Jan 1, 2019
Rebecca Adams Individual Corporate DirectorBoard of Director Jan 1, 2024
Brian Amdahl Individual Corporate DirectorBoard of Director Jan 1, 2020
Cindy Feyder Individual Corporate DirectorDirector Jan 1, 2020
Malissa Jean Bahr Individual Corporate DirectorBoard of Director Jan 1, 2024
Keith Murphy Individual Corporate DirectorBoard of Director Jan 1, 2020
Connie Hendershott Individual Corporate DirectorBoard of Director Jan 1, 2023
Simon L Lick Individual Corporate DirectorDirector Jan 1, 2020
Thomas McBride Individual Corporate DirectorBoard of Director Jan 1, 2022
Jean a Macdonell Individual Corporate OfficerVP of Clinic Services Aug 23, 2010
W-2 Managing EmployeeVP of Clinic Services Aug 23, 2010
Melinda Nuhring Individual Corporate DirectorBoard of Director Jan 1, 2021
Jeoff Thomas Will Individual Corporate DirectorBoard of Director Jan 1, 2024
Kyle Hedlund Individual Corporate DirectorBoard of Director Jan 1, 2025

Owners & managing parties with NPI records 3

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

Subparts reporting this organization as parent 4

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 583

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 583

Affiliated clinicians 231

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

View all 231

NPI Registry JSON

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739491200000",
    "number": "1669426631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 UNIVERSITY AVE W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551043727",
            "telephone_number": "612-672-6740",
            "fax_number": "612-884-3592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 GOLF COURSE RD",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557448648",
            "telephone_number": "218-326-3401",
            "fax_number": "218-999-1461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND ITASCA CLINIC AND HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-22",
        "last_updated": "2025-02-14",
        "certification_date": "2025-02-14",
        "status": "A",
        "authorized_official_last_name": "CHRISTENSEN",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "218-999-1702"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "MN",
            "license": null,
            "primary": false
        },
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "MN",
            "license": "330789",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "038345700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MN

Sources for this page

Verify at the official NPI Registry.