NPIMap

Organization Active NPI

Glendive Medical Center, Inc

  • Skilled Nursing Facility
  • Glendive, MT
National Provider Identifier
1700896941
Registry record updated Mar 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
10704 Issued in MT
Legal business name
GLENDIVE MEDICAL CENTER, INC
Practice address
202 Prospect Dr
Glendive, MT 59330-1943
Phone
(406) 345-3306
Fax
(406) 345-3358
NPI assigned
Aug 9, 2006
Last updated
Mar 4, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2021

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

Authorized official

Name
William Robinson
Title
VP of Financial Services
Phone
(406) 345-3301

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 10704 MT Primary

Addresses

Primary practice location

202 Prospect Dr
Glendive, MT 59330-1943

Mailing address

202 Prospect Dr
Glendive, MT 59330-1943
Phone (406) 345-3306

Other identifiers 2

IdentifierTypeStateIssuer
0000316615MedicaidMT
000082OtherMTSKILLED NURSING FACILITY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060817000255 MT Part A Provider - Skilled Nursing Facility 7214846823 Practice locations: Glendive, MT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700896941. Details of each certification follow.

Skilled nursing facility certification: CCN 275067

Legal name
GLENDIVE MEDICAL CENTER INC
Doing business as
GLENDIVE MEDICAL CENTER NURSING HOME
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Aug 1, 1977
Last certification
Aug 1, 2024
Beds
36
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 27, 1964 in MT
Enrollment address
202 Prospect Dr
Glendive, MT 59330-1943
Nursing home name
GLENDIVE MEDICAL CENTER N H

Other NPIs with the same Medicare PAC ID 5

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Glendive Medical Center N HCCN 275067 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Aug 1, 1977
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
3634.8 residents per day on average
Penalties (3 years)
2Fines totaling $20,027

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Glendive Medical Ctr12 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.

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
A'Lynn Shields Individual Corporate DirectorBoard Director May 1, 2016
Maria Buniel Individual Corporate OfficerBoard of Director Jul 24, 2025
Parker a Powell Individual Corporate OfficerChief Executive Officer Oct 11, 2013
Operational/Managerial Control Oct 11, 2013
Adp of the SNF Oct 14, 2013
Jill Domek Individual Operational/Managerial Control Jul 1, 2007
Adp of the SNF Jul 1, 2007
Lesley Gibbs Individual Corporate DirectorBoard Director Feb 27, 2025
Mitchell T Goplen Individual Corporate DirectorBoard Director Jul 28, 2016
Randy H Thompson Individual Corporate DirectorBoard Director Jul 1, 2024
Joseph M Leal Individual Corporate DirectorBoard Director Feb 25, 2021
Billings Clinic Organization, Billings, MT Corporation, Non-profit Operational/Managerial Control Sep 1, 2013
Adp of the SNF Dec 26, 2024
Clifford Reske Individual Operational/Managerial Control May 3, 2012
Adp of the SNF May 3, 2012
Chrystal Lynn Potter Individual Corporate DirectorBoard Director Jan 1, 2016
Janette Bogar Individual Corporate DirectorBoard Director Feb 25, 2021
Troy D Myers Individual Corporate DirectorBoard Director Feb 23, 2023
William Robinson Individual Corporate OfficerVice-President of Financial Service Aug 3, 2015
Adp of the SNF Aug 3, 2015

Owners & managing parties with NPI records 12

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

Facilities with the same owner 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614816000000",
    "number": "1700896941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 PROSPECT DR",
            "city": "GLENDIVE",
            "state": "MT",
            "postal_code": "593301943",
            "telephone_number": "406-345-3306",
            "fax_number": "406-345-3358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 PROSPECT DR",
            "city": "GLENDIVE",
            "state": "MT",
            "postal_code": "593301943",
            "telephone_number": "406-345-3306",
            "fax_number": "406-345-3358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENDIVE MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-09",
        "last_updated": "2021-03-04",
        "certification_date": "2021-03-04",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "VP OF FINANCIAL SERVICES",
        "authorized_official_telephone_number": "406-345-3301"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MT",
            "license": "10704",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000316615",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SKILLED NURSING FACILITY",
            "identifier": "000082",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendive, MT

Sources for this page

Verify at the official NPI Registry.