Appleton Area Health
Organization Active NPI Rural Health Clinic/Center · Appleton, MN
NPI 1730126673 · NPPES record last updated May 31, 2023
Key facts
- NPI
- 1730126673
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- APPLETON AREA HEALTH
- Practice address
- 30 S. Behl St.
Appleton, MN 56208 - Phone
- (320) 289-1580
- Fax
- (320) 289-8538
- NPI assigned
- May 31, 2006
- Organization subpart
- No
Authorized official
- Name
- Jacob William Redepenning
- Title
- Cfo
- Phone
- (320) 289-8514
Owners & managing parties with NPI records 3
Other NPIs on the same Medicare enrollment 4
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 4
Related certifications (CCN) 1
Practitioners 30
-
Lisa Marie Baker, MD
-
Shawna Marie Benson, PSY. D., LP
-
Elizabeth Charles, CNM
-
Deborah S Colon, APRN, CNP
-
Lisa Joy Decathelineau, LMFT
-
Mitchell William Ejnik, PMHNP
-
Brittany Lee Hamann, PSYD, MA, LPCC
-
William J Lee, M.D.
-
Brandon Osbon, MD
-
Lesa Jo Thielke, APRN, FNP-C
-
Kelsey L Tollefson, MSW, LICSW
-
Crystal Rae Turner, FNP
-
Caren A Gayle, LCSW
-
Robert Payne, M.D.
-
Tonya L Diggins, CNP/CNM
-
Larry Jay Grong, D.O.
-
Martin Heinz Janning, M.D.
-
Marcia S Kells, RN CNP
-
Yuan Stevenson, M.D.
-
Penny M Hormann, APRN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
Rural health clinic certification: CCN 243467
- Legal name
- APPLETON AREA HEALTH
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Apr 3, 2013
- Last certification
- Feb 19, 2020
- Ownership / control type
- 2A
- Organization structure
- Other · Non-profit
- Enrollment address
- 30 S Behl St
Appleton, MN 56208-1616 - Related CCNs
- 241341
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Jacob William Redepenning |
Corporate Officer |
Dec 13, 2017 | |
| W-2 Managing Employee |
Dec 13, 2017 | ||
| Gregory Miner |
Corporate Officer |
Dec 31, 2021 | |
| W-2 Managing Employee |
Dec 31, 2021 | ||
| Appleton Area Health |
Operational/Managerial Control | Oct 16, 2012 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060818000114 | MN | Part B Supplier - Clinic/Group Practice | 7618952565 |
Receives reassigned benefits from 28 practitioners 5 other NPIs on this enrollment Practice locations: Appleton, MN; Hancock, MN |
| O20121217000417 | MN | Part a Provider - Rural Health Clinic | 7618952565 | Practice locations: Appleton, MN |
National Provider Directory
- Tax ID family
- Appleton Municipal Hospital
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | MN | ||
| Rural Health Clinic/Center | 261QR1300X | MN | Yes |
Addresses
Primary practice location
30 S. Behl St.
Appleton, MN 56208
Mailing address
30 S. Behl St.
Appleton, MN 56208
Phone (320) 289-1580
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 294310700 | Medicaid | MN |
Other providers in Appleton, MN
- Appleton Area Health
- Appleton Area Health
- Appleton Area Health
- Appleton Dental Care, P.a.
- Florante S Austria
- Kenneth Harold Blasing
- Paige Brittaney Burkel
- Elizabeth Charles
All providers in Appleton, MN · Rural Health Clinic/Center in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 31, 2023. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.