St Marys Regional Health Center
Organization Active NPI Home Health Agency · Detroit Lakes, MN
NPI 1720078686 · NPPES record last updated Mar 1, 2024
Key facts
- NPI
- 1720078686
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- Legal business name
- ST MARYS REGIONAL HEALTH CENTER
- Practice address
- 114 Frazee St E
Detroit Lakes, MN 56501 - Phone
- (218) 847-0808
- Fax
- (218) 847-0850
- NPI assigned
- Oct 24, 2005
- Organization subpart
- Yes
- Parent organization (as reported)
- ESSENTIA HEALTH
Authorized official
- Name
- Alan James Hurley
- Title
- Coo
- Phone
- (979) 820-4247
Owners & managing parties with NPI records 11
-
Benjamin C Smith, MD
Other NPIs with the same Medicare PAC ID 11
Corporate family (same tax ID) 10
Member of 1
Facilities with the same owner 50
Practitioners 190
-
Ryan Ahlgren, NP
-
Molly Mae Anderson, PMHNP
-
Anita Bagstad, APRN,CNP
-
Susan Bauer, D.O.
-
Benita Behm, MD
-
Sarah A Bement, PA-C
-
David C Benson, MD
-
Kari J Bergman, APRN, CNP
-
Lisa D Bojado, NP
-
Tricia Rae Brein, MD
-
Nathan Brunken, MD
-
Isabella M Byer, DPT
-
Michelle Dawn Crissinger, APRN, CNP
-
Ranae Doll, MD
-
Sydney Leigh Eckhoff, APRN,CNP
-
Vonda Eidenschink, PA-C
-
Krystal Enger, PA-C
-
Michelle R England, MSW
-
Rachel Diane Erickson, APRN, CNP
Affiliated clinicians 53
-
Benita Behm, MD
-
Chentel Spring Dangerud, PA-C
-
Krystal Enger, PA-C
-
Tammi L Fuchs, FNP-C
-
Katie A Gurskis, NP-C
-
Alissa Jo Hoban, APRN, CNP
-
Brent M Jansen, APRN, NPC
-
Carrie Amanda Lahr, APRN/CNP
-
Laura Lou Lhotka, MD
-
Jessica Lindblom, CNP
-
Melanie Markuson, APRN, CNP
-
Gaurav Suresh Mehta, M.D.
-
Hope E. Meyer, M.D.
-
Tamera Ostenaa, APRN, CNP
-
Angela Marie Skyberg, PA-C
-
Emily Marie Stueness, PA-C
Medicare Care Compare: Home health agency
- Listed as
- Essentia Health Home Care West
- Overall star rating
- ★★★★☆ 4 of 5
- Ownership
- Non-Profit
- Certified
- Feb 27, 1997
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Home health agency certification: CCN 248052
- Legal name
- ST MARYS REGIONAL HEALTH CENTER
- Doing business as
- ESSENTIA HEALTH HOME CARE WEST
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Feb 27, 1997
- Last certification
- Sep 14, 2018
- Ownership / control type
- Non-Profit
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 114 Frazee St E
Detroit Lakes, MN 56501-3502
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Stefanie Gefroh Ellison |
Corporate Officer |
Aug 12, 2024 | |
| Tim D Heilman |
Corporate Director |
Jan 1, 2020 | |
| Marc Adams |
Corporate Director |
Jan 1, 2026 | |
| Mark Krejci |
Corporate Director |
Jan 1, 2026 | |
| Kimberly Pladson |
Corporate Director |
Jan 1, 2025 | |
| Essentia Health |
5% Or Greater Direct Ownership Interest | Jul 1, 2023 | 100% |
| James M Christensen |
Corporate Director |
Jan 1, 2020 | |
| Kevin S Boren |
Corporate Officer |
Sep 29, 2025 | |
| Taylor Grant Mertz |
Corporate Director |
May 17, 2022 | |
| Anderson Saint Georges |
Corporate Director |
Jan 1, 2025 | |
| Michael Watters |
Corporate Officer |
Jul 1, 2023 | |
| Alan J Hurley |
Corporate Officer |
May 18, 2023 | |
| W-2 Managing Employee |
May 18, 2023 | ||
| Benjamin Cody Smith |
Corporate Director |
May 17, 2022 | |
| Douglas J Arvin |
Corporate Officer |
May 18, 2023 | |
| W-2 Managing Employee |
May 18, 2023 | ||
| Laurie Ann Lewandowski |
Corporate Director |
Jan 1, 2017 | |
| Innovis Health LLC |
Operational/Managerial Control | Jan 1, 2011 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060330000577 | MN | Part a Provider - Home Health Agency | 2062326820 | Practice locations: Fosston, MN; Fargo, ND; Detroit Lakes, MN; Ada, MN |
National Provider Directory
- Tax ID family
- St Marys Regional HLTH
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Registered Nurse |
163WC1500X | |||
| Home Health Agency | 251E00000X | Yes |
Addresses
Primary practice location
114 Frazee St E
Detroit Lakes, MN 56501
Mailing address
114 Frazee St E
Detroit Lakes, MN 56501-3502
Phone (218) 847-0808
Other practice location 1
201 9th St W
Ada, MN 56510-1279
Phone (218) 784-2205
Other practice location 2
3362 35th Ave S
Fargo, ND 58104-8835
Phone (701) 364-3010
Other practice location 3
900 Hilligoss Blvd SE
Fosston, MN 56542-1542
Phone (218) 435-7670
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 892442000 | Medicaid | MN |
Other names
- Essentia Health Home Care West
Other providers in Detroit Lakes, MN
- St Mary'S Regional Health Center
- St Mary'S Regional Health Center
- St Marys EMS
- St Marys Regional Health Center
- St Marys Regional Health Center
- St. Mary'S Regional Health Center
- St. Mary'S Regional Health Center
- St. Marys Regional Health Center
- Patricia Marie Stalberger
- Kiah G Staloch
All providers in Detroit Lakes, MN · Home Health Agency in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 1, 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.