NPIMap

Organization Active NPI

PSJ Acquisition LLC

Doing business as Prairie St John's

  • Psychiatric Hospital
  • Fargo, ND
National Provider Identifier
1679709802
Registry record updated Apr 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
PSJ ACQUISITION LLC
Doing business as
Prairie St John's
Practice address
510 4TH St S
Fargo, ND 58103
Phone
(701) 476-7200
Fax
(701) 280-5789
NPI assigned
Jun 2, 2009
Last updated
Apr 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2024

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

Authorized official

Name
Steve Filton
Title
SRVP Cfo
Phone
(610) 768-3300

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X Primary
Psychiatry Physician 2084P0800X

Addresses

Primary practice location

510 4TH St S
Fargo, ND 58103

Mailing address

510 4TH St S
Fargo, ND 58103
Phone (701) 476-7200

Other practice location 1

390 6th Ave S
Fargo, ND 58103-1918
Phone (701) 476-7200

Other identifiers 2

IdentifierTypeStateIssuer
99725100MedicaidMN
11051MedicaidND

Other names 1

  • Prairie St John's Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090918000240 ND Part B Supplier - Clinic/Group Practice 7012062235 Receives reassigned benefits from 68 practitioners
1 other NPI on this enrollment
Practice locations: Fargo, ND
O20091001000127 ND Part A Provider - Hospital 7012062235 1 other NPI on this enrollment
Practice locations: Fargo, ND

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679709802. Details of each certification follow.

Hospital certification: CCN 354004

Legal name
PSJ ACQUISITION LLC
Doing business as
PRAIRIE ST JOHNS
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Jun 4, 1997
Last certification
Apr 4, 2001
Beds
110
Ownership / control type
Private (for profit)
Most recent change of ownership
Sep 1, 2009 (1 total)
Organization structure
LLCProprietary
Incorporated
Feb 10, 2009 in ND
Enrollment address
510 4TH St S
Fargo, ND 58103-1914
Main/Primary Hospital Location
Hospital subgroups
Psychiatric

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
Prairie St John'sCCN 354004 · All quality measures
Type
Psychiatric
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory

Locations

2925 20th St S
Moorhead, MN 56560
Phone (218) 284-0300

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
George H Brunner Individual Corporate OfficerAssistant Secretary Nov 15, 2010 100%
Carol Ann Frovarp Individual Contracted Managing EmployeeCfo Feb 1, 2019
Corporate OfficerCfo Feb 1, 2019
Psychiatric Solutions Hospitals LLC Organization, King of Prussia, PA LLC 5% Or Greater Direct Ownership Interest Feb 10, 2009 100%
Katharine M Lyver Individual Corporate OfficerAssistant Treasurer Jan 1, 2024 100%
Matthew D Klein Individual Corporate OfficerSecretary Nov 15, 2010 100%
Matthew J Peterson Individual Corporate OfficerPresident Sep 19, 2019 100%
Corporate DirectorPresident Sep 19, 2019 33.3%
Operational/Managerial ControlPresident Sep 19, 2019 100%
Tyrel J Hegland Individual Contracted Managing EmployeeCeo Mar 10, 2023
Corporate OfficerCeo Mar 10, 2023
Thomas M Day Individual Corporate OfficerVice President Jul 21, 2021 100%
Corporate DirectorVice President Jul 21, 2021 33.3%
Steve Filton Individual Corporate OfficerVice President and Board Member Nov 15, 2010 100%
Corporate DirectorVice President and Board Member Nov 15, 2010 33.3%
Operational/Managerial ControlVice President and Board Member Nov 15, 2010 100%
Cheryl K Ramagano Individual Corporate OfficerTreasurer Nov 15, 2010 100%
Universal Health Services Inc Organization, King of Prussia, PA Corporation 5% Or Greater Indirect Ownership Interest Nov 15, 2010 100%
James M Coleman Individual Contracted Managing EmployeeSenior Reimbursement Manager Nov 15, 2010 50%
Uhs of Delaware Inc Organization, King of Prussia, PA Corporation Operational/Managerial Control Nov 15, 2010 100%
Psychiatric Solutions, Inc. Organization, Franklin, TN Corporation 5% Or Greater Indirect Ownership Interest Feb 10, 2009 100%
Alan B Miller Individual 5% Or Greater Indirect Ownership InterestChairman Mar 25, 2022 86.5%

Facilities with the same owner 172

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 172

Practitioners & affiliated clinicians

Practitioners 101

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 101

NPI Registry JSON

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

{
    "created_epoch": "1243900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714348800000",
    "number": "1679709802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 4TH ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "58103",
            "telephone_number": "701-476-7200",
            "fax_number": "701-280-5789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 4TH ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "58103",
            "telephone_number": "701-476-7200",
            "fax_number": "701-280-5789"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "390 6th Ave S",
            "address_purpose": "LOCATION",
            "city": "Fargo",
            "state": "ND",
            "postal_code": "581031918",
            "country_code": "US",
            "telephone_number": "701-476-7200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PSJ ACQUISITION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-02",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A",
        "authorized_official_last_name": "FILTON",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "SRVP CFO",
        "authorized_official_telephone_number": "610-768-3300"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "99725100",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11051",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prairie St John's",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.