NPIMap

Organization Active NPI

Mercy Medical Center

Doing business as CHI St Alexius Health Williston

  • Certified Registered Nurse Anesthetist
  • Williston, ND
National Provider Identifier
1700990041
Registry record updated Nov 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
5052A Issued in ND
Legal business name
MERCY MEDICAL CENTER
Doing business as
CHI St Alexius Health Williston
Practice address
1301 15TH Ave W
Williston, ND 58801-3821
Phone
(701) 774-7470
Fax
(701) 774-7479
NPI assigned
Aug 17, 2006
Last updated
Nov 17, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2016

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

Authorized official

Name
Joseph Ruark
Title
VP-Operational Finance
Phone
(701) 774-7400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 5052A ND Primary

Addresses

Primary practice location

1301 15TH Ave W
Williston, ND 58801-3821

Mailing address

1301 15TH Ave W
Williston, ND 58801-3821
Phone (701) 774-7470

Other identifiers 2

IdentifierTypeStateIssuer
000098001OtherNDBLUE CROSS OF ND
01247MedicaidND

Other names 1

  • CHI St Alexius Health Williston Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031230000336 ND Part B Supplier - Clinic/Group Practice 7416851381 Receives reassigned benefits from 288 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Williston, ND; Tioga, ND

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
Marco a Rancier MD8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1301 15th Ave W
Williston, ND 58801
Phone (701) 774-7400

Practitioners & affiliated clinicians

Practitioners 22

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.

  • Luann M Cederstrom, CRNA
    • Certified Registered Nurse Anesthetist
    • Minot, ND
    • NPI 1184712515

    Nurse Anesthetist, Certified Registered

    NPD
  • Cody Chathams, CRNA
    • Certified Registered Nurse Anesthetist
    • Fargo, ND
    • NPI 1528485141

    Nurse Anesthetist, Certified Registered

    NPD
  • Karen L. Johnson, CRNA
    • Certified Registered Nurse Anesthetist
    • Williston, ND
    • NPI 1073841227

    Nurse Anesthetist, Certified Registered

    NPD
  • Curtis C Krueger, CRNA
    • Certified Registered Nurse Anesthetist
    • Grand Forks, ND
    • NPI 1952341026

    Nurse Anesthetist, Certified Registered

    NPD
  • Holden McCall
    • Certified Registered Nurse Anesthetist
    • Williston, ND
    • NPI 1891362901

    Single Specialty

    NPD
  • Lina Ricketts, DNP, CRNA
    • Certified Registered Nurse Anesthetist
    • Williston, ND
    • NPI 1508527755

    Nurse Anesthetist, Certified Registered

    NPD
  • Kristi Jo Syverson, CRNA
    • Certified Registered Nurse Anesthetist
    • Minot, ND
    • NPI 1336496579

    Nurse Anesthetist, Certified Registered

    NPD
  • Kory M Albert, CRNA
    • Certified Registered Nurse Anesthetist
    • Port Townsend, WA
    • NPI 1326148859

    Nurse Anesthetist, Certified Registered

    NPD
  • Dirk Bradley Bahoravitch, MSN, CRNA
    • Certified Registered Nurse Anesthetist
    • Provo, UT
    • NPI 1184083826

    Nurse Anesthetist, Certified Registered

    NPD
  • Kyle L Bohling, CRNA
    • Certified Registered Nurse Anesthetist
    • Rapid City, SD
    • NPI 1497862692

    Nurse Anesthetist, Certified Registered

    NPD
  • Scarlett Brandi Hinson, CRNA
    • Certified Registered Nurse Anesthetist
    • Marianna, FL
    • NPI 1992789366

    Nurse Anesthetist, Certified Registered

    NPD
  • Janet Elizabeth Isaacs, CRNA
    • Certified Registered Nurse Anesthetist
    • Phoenix, AZ
    • NPI 1386662393

    Nurse Anesthetist, Certified Registered

    NPD
View all 22

NPI Registry JSON

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479340800000",
    "number": "1700990041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 15TH AVE W",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588013821",
            "telephone_number": "701-774-7470",
            "fax_number": "701-774-7479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 15TH AVE W",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588013821",
            "telephone_number": "701-774-7470",
            "fax_number": "701-774-7479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2016-11-17",
        "status": "A",
        "authorized_official_last_name": "RUARK",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "VP-OPERATIONAL FINANCE",
        "authorized_official_telephone_number": "701-774-7400"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ND",
            "license": "5052A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF ND",
            "identifier": "000098001",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01247",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHI St Alexius Health Williston",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Williston, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.