PSJ Acquisition LLC
Organization Active NPI Psychiatric Hospital · Fargo, ND
NPI 1679709802 · NPPES record last updated Apr 29, 2024
Key facts
- NPI
- 1679709802
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatric Hospital 283Q00000X
- Legal business name
- PSJ ACQUISITION LLC
- Practice address
- 510 4TH St S
Fargo, ND 58103 - Phone
- (701) 476-7200
- Fax
- (701) 280-5789
- NPI assigned
- Jun 2, 2009
- Organization subpart
- No
Authorized official
- Name
- Steve Filton
- Title
- SRVP Cfo
- Phone
- (610) 768-3300
Other NPIs on the same Medicare enrollment 1
Facilities with the same owner 172
Practitioners 101
-
Fetih Akgul, MD
-
Rachel D Barnick, APRN, CNP
-
Mailyn Marie Mozingo, PMHNP
-
Lisa Schock, M.D.
-
Sarah Terpstra, PMHNP
-
Molly Wambach, APRN-FNP
-
Carol A Whitman, MD
-
Hunter Caskey, M.D.
-
Gina Marie Cook, FNP-BC
-
Tracy Kay Fiser, APRN
-
Arpit Singh Heer, MD
-
Jessie Marie Kier, DNP, APRN, FNP-BC
-
Catherine Mier, M.D.
-
Kathryn Ney, MD
-
Joshua Reider, MD
-
Parker S Rosenau, MD
-
Derek Michael Smith, M.D.
-
Eric C Tee, M.D.
Medicare Care Compare: Hospital
- Listed as
- Prairie St John'S
- Type
- Psychiatric
- Ownership
- Proprietary
- Medicare certification status
- Active
- Emergency services
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ND
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
- LLC · Proprietary
- Incorporated
- Feb 10, 2009 in ND
- Enrollment address
- 510 4TH St S
Fargo, ND 58103-1914 - Hospital subgroups
- Psychiatric
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| George H Brunner |
Corporate Officer |
Nov 15, 2010 | 100% |
| Carol Ann Frovarp |
Contracted Managing Employee |
Feb 1, 2019 | |
| Corporate Officer |
Feb 1, 2019 | ||
| Psychiatric Solutions Hospitals LLC |
5% Or Greater Direct Ownership Interest | Feb 10, 2009 | 100% |
| Katharine M Lyver |
Corporate Officer |
Jan 1, 2024 | 100% |
| Matthew D Klein |
Corporate Officer |
Nov 15, 2010 | 100% |
| Matthew J Peterson |
Corporate Officer |
Sep 19, 2019 | 100% |
| Corporate Director |
Sep 19, 2019 | 33.3% | |
| Operational/Managerial Control |
Sep 19, 2019 | 100% | |
| Tyrel J Hegland |
Contracted Managing Employee |
Mar 10, 2023 | |
| Corporate Officer |
Mar 10, 2023 | ||
| Thomas M Day |
Corporate Officer |
Jul 21, 2021 | 100% |
| Corporate Director |
Jul 21, 2021 | 33.3% | |
| Steve Filton |
Corporate Officer |
Nov 15, 2010 | 100% |
| Corporate Director |
Nov 15, 2010 | 33.3% | |
| Operational/Managerial Control |
Nov 15, 2010 | 100% | |
| Cheryl K Ramagano |
Corporate Officer |
Nov 15, 2010 | 100% |
| Universal Health Services Inc |
5% Or Greater Indirect Ownership Interest | Nov 15, 2010 | 100% |
| James M Coleman |
Contracted Managing Employee |
Nov 15, 2010 | 50% |
| Uhs of Delaware Inc |
Operational/Managerial Control | Nov 15, 2010 | 100% |
| Psychiatric Solutions, Inc. |
5% Or Greater Indirect Ownership Interest | Feb 10, 2009 | 100% |
| Alan B Miller |
5% Or Greater Indirect Ownership Interest |
Mar 25, 2022 | 86.5% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician |
2084P0800X | |||
| Psychiatric Hospital | 283Q00000X | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11051 | Medicaid | ND | |
| 99725100 | Medicaid | MN |
Other names
- Prairie St John's
Other providers in Fargo, ND
- Terra L Provost
- PRX Performance
- Christine Pryor
- Alison Noel Przybilla
- Psi Surgical Center LLC
- PSJ Acquisition LLC
- Taylor Jon Ptacek
- Sheyenne Laureen Puetz
- Bimala Pulami
- Rebecca Pulkrabek
All providers in Fargo, ND · Psychiatric Hospital in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 29, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.