NPIMap

Organization Active NPI

CCM Health

  • Critical Access Hospital
  • Montevideo, MN
National Provider Identifier
1720086028
Registry record updated Jan 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
327693 Issued in MN
Legal business name
CCM HEALTH
Practice address
824 N 11TH St
Montevideo, MN 56265
Phone
(320) 269-8877
Fax
(320) 269-8186
NPI assigned
Jul 11, 2005
Last updated
Jan 19, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2023

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

Authorized official

Name
Deserae Anspach
Title
Cfo
Phone
(320) 269-8877

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X MN
Critical Access Hospital 282NC0060X 327693 MN Primary

Addresses

Primary practice location

824 N 11TH St
Montevideo, MN 56265

Mailing address

824 N 11TH St
Montevideo, MN 56265-1629
Phone (320) 269-8877

Other identifiers 1

IdentifierTypeStateIssuer
855345900MedicaidMN

Other names 1

  • Chippewa County Montevideo Hospital Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031201000642 MN Part B Supplier - Clinic/Group Practice 4284539453 Receives reassigned benefits from 112 practitioners
Practice locations: Montevideo, MN; Clara City, MN; Milan, MN
O20060504000810 MN Part A Provider - Critical Access Hospital 4284539453 Receives reassigned benefits from 150 practitioners
1 other NPI on this enrollment
Practice locations: Clara City, MN; Milan, MN; Montevideo, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720086028. Details of each certification follow.

Hospital certification: CCN 241325

Legal name
CCM HEALTH
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jan 1, 2002
Last certification
Dec 11, 2024
Beds
30 (25 certified)
Ownership / control type
Local
Organization structure
GovernmentNon-profit
Incorporated
Jan 1, 2002 in MN
Enrollment address
824 N 11TH St
Montevideo, MN 56265-1629
Other Hospital Practice Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 1

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

  • CCM Health

    dba Chippewa County Montevideo Hospital Urgent Care

    • Urgent Care Clinic/Center
    • Montevideo, MN
    • NPI 1275057978

    O20060504000810

    Same enrollment

Care Compare: Hospital

Medicare Care Compare
Listed as
Chippewa County HospitalCCN 241325 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

1401 Nwakama St
Ste 100
Marshall, MN 56258
Phone (320) 269-8877

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
City of Montevideo Organization, Montevideo, MN 5% Or Greater Direct Ownership Interest Nov 17, 2007 50%
Mark W Rekow Individual Corporate Officer Jan 1, 2010 16%
Nathan Schmidt Individual Corporate Officer Jan 1, 2014 16%
Deserae Anspach Individual Operational/Managerial ControlCfo Jan 9, 2012
Nicholas Krueger Individual Corporate Officer Apr 1, 2013 16%
Lydia D Kranz Individual W-2 Managing EmployeeMedical Staff Services Manager Apr 25, 2018 5%
Operational/Managerial ControlMedical Staff Services Manager Aug 1, 2017
Candice Jaenisch Individual Corporate Officer Jan 1, 2021 16%
Steve Condon Individual Corporate Officer Jan 1, 2017 16%
Operational/Managerial ControlAdministrator May 17, 2004 100%
Patricia J Frank Individual Operational/Managerial ControlCno / Coo Oct 15, 2018
Brian a Lovdahl Individual Corporate OfficerCeo Jun 1, 2018 100%
David Lieser Individual Corporate Officer Jan 1, 2018 16%
Steven M Sulflow Individual Corporate OfficerBoard Member Jan 1, 2021 16%
Chippewa County Organization, Montevideo, MN 5% Or Greater Direct Ownership Interest Nov 12, 2007 50%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 6

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

  • CCM Health

    dba CCM Health Home Care

    • Home Health Agency
    • Montevideo, MN
    • NPI 1275751950

    Chippewa County, City of Montevideo

    CMS ownership
  • CCM Health

    dba Chippewa County Montevideo Hospital Swing Bed

    • Medicare Defined Swing Bed Hospital Unit
    • Montevideo, MN
    • NPI 1346460755

    Chippewa County, City of Montevideo

    CMS ownership
  • CCM Health
    • Rural Health Clinic/Center
    • Montevideo, MN
    • NPI 1407636475

    Chippewa County, City of Montevideo

    CMS ownership
  • CCM Health
    • Rural Health Clinic/Center
    • Milan, MN
    • NPI 1457132466

    Chippewa County, City of Montevideo

    CMS ownership
  • CCM Health
    • Rural Health Clinic/Center
    • Marshall, MN
    • NPI 1487436655

    Chippewa County, City of Montevideo

    CMS ownership
  • CCM Health
    • Rural Health Clinic/Center
    • Clara City, MN
    • NPI 1679354690

    Chippewa County, City of Montevideo

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 210

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 210

Affiliated clinicians 116

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

View all 116

NPI Registry JSON

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

{
    "created_epoch": "1121040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674086400000",
    "number": "1720086028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 N 11TH ST",
            "city": "MONTEVIDEO",
            "state": "MN",
            "postal_code": "562651629",
            "telephone_number": "320-269-8877",
            "fax_number": "320-269-8186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 N 11TH ST",
            "city": "MONTEVIDEO",
            "state": "MN",
            "postal_code": "56265",
            "telephone_number": "320-269-8877",
            "fax_number": "320-269-8186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCM HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-11",
        "last_updated": "2023-01-19",
        "certification_date": "2023-01-19",
        "status": "A",
        "authorized_official_last_name": "ANSPACH",
        "authorized_official_first_name": "DESERAE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "320-269-8877"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MN",
            "license": null,
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MN",
            "license": "327693",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "855345900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chippewa County Montevideo Hospital",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Chippewa County Montevideo Hospital",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Montevideo, MN

Sources for this page

Verify at the official NPI Registry.