NPIMap

Hazen Memorial Hospital Association

Organization Active NPI Critical Access Hospital · Hazen, ND

NPI 1700965696 · NPPES record last updated Mar 25, 2024

Key facts

NPI
1700965696
Entity type
Organization (NPI type 2)
Primary specialty
Critical Access Hospital 282NC0060X
License
5024A (ND)
Legal business name
HAZEN MEMORIAL HOSPITAL ASSOCIATION
Practice address
510 8TH Ave NE
Hazen, ND 58545-4637
Phone
(701) 748-2225
Fax
(701) 639-4343
NPI assigned
Nov 3, 2006
Organization subpart
No

Authorized official

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

Owners & managing parties with NPI records 3

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

Owned or controlled facilities with NPI records 1

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

Other NPIs on the same Medicare enrollment 2

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

Other NPIs with the same Medicare PAC ID 2

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

Facilities with the same owner 1

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

Practitioners 48

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 48

Affiliated clinicians 108

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

View all 108

Medicare Care Compare: Hospital

Listed as
Sakakawea Medical Center - Cah CCN 351310
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
Active (Provider of Services file)
Emergency services
Yes

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (3 enrollments) in ND

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
Corporation · Non-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
Corporation · Non-profit
Incorporated
Oct 21, 1943 in ND
Enrollment address
510 8TH Ave NE
Hazen, ND 58545-4637
Hospital Swing-Bed Unit

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 Director
Board Member		 Nov 1, 2012
Corporate Director Nov 1, 2012
Frederick Stern
Individual 		Corporate Director
Board Member		 Nov 1, 2017
Corporate Director Oct 25, 2007
Kari Cutting
Individual 		Corporate Director
Board Member		 Nov 1, 2023
Wayne Hoffner
Individual 		Corporate Director
Board Member		 Jun 24, 2021
Corporate Director Jun 24, 2021
Martha Raad
Individual 		Corporate Director
Board Member		 Dec 30, 2021
Corporate Director Dec 30, 2021
Kayla Palmer
Individual 		Corporate Director
Board Member		 Nov 1, 2024
Kurt V Waldbillig
Individual 		Corporate Officer
Ceo		 Nov 1, 2023
Donlyn J Erickson
Individual 		Corporate Director
Board Member		 Mar 1, 2012
Corporate Director Mar 1, 2012
Jesse Krieger
Individual 		Corporate Director
Board Member		 Dec 30, 2021
Corporate Director Dec 30, 2021
Myria Perry
Individual 		Corporate Director
Board Member		 Nov 1, 2004
Corporate Director Oct 23, 2009
Melissa Dillman
Individual 		Corporate Officer
Cfo		 Apr 1, 2020
W-2 Managing Employee
Cfo		 Feb 11, 2022
Corporate Officer Apr 1, 2020
W-2 Managing Employee Feb 11, 2022
Daren Eliason
Individual 		Corporate Director
Board Member		 Dec 30, 2021
Corporate Director Dec 30, 2021
Rachel Connolly
Individual 		Corporate Director
Board Member		 Dec 30, 2021
Corporate Director Dec 30, 2021
Todd Lindquist
Individual 		Corporate Director
Board 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%

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 Hospice
Hazen, ND · CCN 351512		 Hospice Operational/Managerial Control (100%) Apr 1, 1996

Medicare enrollment records

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

National Provider Directory

Specialties & licenses

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

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

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

Other names

  • Sakakawea Medical Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 25, 2024.

{
    "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",
            "identifier": "2766",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14525",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS HOSPICE NUMBER",
            "identifier": "009886",
            "state": "ND"
        },
        {
            "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": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS CLINIC",
            "identifier": "00340001",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "59258",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D01027",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "50199",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sakakawea Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hazen, ND

All providers in Hazen, ND · Critical Access Hospital in North Dakota

Sources for this page

Verify at the official NPI Registry.