NPIMap

Organization Active NPI

Hazen Memorial Hospital Association

Doing business as Sakakawea Medical Center

  • Critical Access Hospital
  • Hazen, ND
National Provider Identifier
1700965696
Registry record updated Mar 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
5024A Issued in ND
Legal business name
HAZEN MEMORIAL HOSPITAL ASSOCIATION
Doing business as
Sakakawea Medical Center
Practice address
510 8TH Ave NE
Hazen, ND 58545-4637
Phone
(701) 748-2225
Fax
(701) 639-4343
NPI assigned
Nov 3, 2006
Last updated
Mar 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2024

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

Authorized official

Name
Mr. Kurt Waldbillig
Title
Ceo
Phone
(701) 748-2225

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 5024A ND Primary

Addresses

Primary practice location

510 8TH Ave NE
Hazen, ND 58545-4637

Mailing address

510 8TH Avenue NE
Hazen, ND 58545
Phone (701) 748-2225

Other identifiers 9

IdentifierTypeStateIssuer
000471OtherNDBCBS NUMBER
009431OtherNDBCBS HH NUMBER
14525MedicaidND
50199MedicaidND
59258MedicaidND
00340001OtherNDBCBS CLINIC
009886OtherNDBCBS HOSPICE NUMBER
2766OtherNDBCBS
D01027MedicaidND

Other names 1

  • Sakakawea Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040827000450 ND Part B Supplier - Clinic/Group Practice 3779558366 Receives reassigned benefits from 45 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Beulah, ND; Hazen, ND
O20041218000062 ND Part A Provider - Critical Access Hospital 3779558366 Receives reassigned benefits from 45 practitioners
Practice locations: Hazen, ND
O20091120000564 ND Part A Provider - Critical Access Hospital 3779558366 Practice locations: Hazen, ND

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1700965696. Details of each certification follow.

Hospital certification: CCN 351310

Legal name
HAZEN MEMORIAL HOSPITAL ASSOCIATION
Doing business as
SAKAKAWEA MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jan 1, 2001
Last certification
May 4, 2022
Beds
13
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Oct 21, 1943 in ND
Enrollment address
510 8TH Ave NE
Hazen, ND 58545-4637
Main/Primary Hospital Location

Hospital certification: CCN 35Z310

Legal name
HAZEN MEMORIAL HOSPITAL ASSOCIATION
Doing business as
SAKAKAWEA MEDICAL CENTER
Organization structure
CorporationNon-profit
Incorporated
Oct 21, 1943 in ND
Enrollment address
510 8TH Ave NE
Hazen, ND 58545-4637
Hospital Swing-Bed Unit

Hospital certification: CCN 350039

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SAKAKAWEA MEDICAL CENTER
Certification status
Terminated Other: provider status change, Dec 31, 2000
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1969
Last certification
Jul 22, 1998
Beds
29
Ownership / control type
Other
Facility address
510 Eighth Ave N E
Hazen, ND 58545

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Sakakawea Medical Center - CahCCN 351310 · 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

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
Robin Richter Individual Corporate DirectorBoard Member Nov 1, 2012
Corporate Director Nov 1, 2012
Frederick Stern Individual Corporate DirectorBoard Member Nov 1, 2017
Corporate Director Oct 25, 2007
Kari Cutting Individual Corporate DirectorBoard Member Nov 1, 2023
Wayne Hoffner Individual Corporate DirectorBoard Member Jun 24, 2021
Corporate Director Jun 24, 2021
Martha Raad Individual Corporate DirectorBoard Member Dec 30, 2021
Corporate Director Dec 30, 2021
Kayla Palmer Individual Corporate DirectorBoard Member Nov 1, 2024
Kurt V Waldbillig Individual Corporate OfficerCeo Nov 1, 2023
Donlyn J Erickson Individual Corporate DirectorBoard Member Mar 1, 2012
Corporate Director Mar 1, 2012
Jesse Krieger Individual Corporate DirectorBoard Member Dec 30, 2021
Corporate Director Dec 30, 2021
Myria Perry Individual Corporate DirectorBoard Member Nov 1, 2004
Corporate Director Oct 23, 2009
Melissa Dillman Individual Corporate OfficerCfo Apr 1, 2020
W-2 Managing EmployeeCfo Feb 11, 2022
Corporate Officer Apr 1, 2020
W-2 Managing Employee Feb 11, 2022
Daren Eliason Individual Corporate DirectorBoard Member Dec 30, 2021
Corporate Director Dec 30, 2021
Rachel Connolly Individual Corporate DirectorBoard Member Dec 30, 2021
Corporate Director Dec 30, 2021
Todd Lindquist Individual Corporate DirectorBoard Member Nov 1, 2012
Corporate Director Nov 1, 2012
Hazen Memorial Hospital Association Organization, Hazen, ND Corporation Operational/Managerial Control Jan 1, 2001
Other Jul 1, 1969 100%

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Sakakawea Medical Center HospiceHazen, ND, CCN 351512 Hospice Operational/Managerial Control (100%) Apr 1, 1996

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 46

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 46

Affiliated clinicians 108

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

View all 108

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711324800000",
    "number": "1700965696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 8TH AVENUE NE",
            "city": "HAZEN",
            "state": "ND",
            "postal_code": "58545",
            "telephone_number": "701-748-2225",
            "fax_number": "701-639-4343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 8TH AVE NE",
            "city": "HAZEN",
            "state": "ND",
            "postal_code": "585454637",
            "telephone_number": "701-748-2225",
            "fax_number": "701-639-4343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAZEN MEMORIAL HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-25",
        "status": "A",
        "authorized_official_last_name": "WALDBILLIG",
        "authorized_official_first_name": "KURT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "701-748-2225",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "ND",
            "license": "5024A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NUMBER",
            "identifier": "000471",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS HH NUMBER",
            "identifier": "009431",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14525",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "50199",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "59258",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS CLINIC",
            "identifier": "00340001",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS HOSPICE NUMBER",
            "identifier": "009886",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "2766",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D01027",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sakakawea Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hazen, ND

Sources for this page

Verify at the official NPI Registry.