NPIMap

Organization Active NPI

St Joseph's Area Health Services

Doing business as St. Joseph's Hospice

  • Community Based Hospice Care Agency
  • Park Rapids, MN
National Provider Identifier
1730185000
Registry record updated Jul 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
325631 Issued in MN
Legal business name
ST JOSEPH'S AREA HEALTH SERVICES
Doing business as
St. Joseph's Hospice
Practice address
323 Main Ave S
Park Rapids, MN 56470-1550
Phone
(218) 732-4552
Fax
(218) 732-1273
NPI assigned
Jun 22, 2005
Last updated
Jul 30, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
ST. JOSEPH'S AREA HEALTH SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 30, 2020

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

Authorized official

Name
Mr. Ben Koppelman
Title
President
Phone
(218) 616-3500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 325631 MN Primary

Addresses

Primary practice location

323 Main Ave S
Park Rapids, MN 56470-1550

Mailing address

600 Pleasant Ave S
Park Rapids, MN 56470-1431
Phone (218) 732-4552

Other identifiers 1

IdentifierTypeStateIssuer
365324200MedicaidMN

Other names 1

  • St. Joseph's Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120120000801 MN Part A Provider - Hospice 0345146510 Practice locations: Park Rapids, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730185000. Details of each certification follow.

Hospice certification: CCN 241546

Legal name
ST. JOSEPH'S AREA HEALTH SERVICES
Doing business as
ST. JOSEPH'S HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Dec 16, 1994
Last certification
Sep 12, 2015
Ownership / control type
Non-Profit - Church
Organization structure
CorporationNon-profit
Incorporated
Dec 19, 1945 in MN
Enrollment address
323 Main S Ave
Park Rapids, MN 56470-1550

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospice

Medicare Care Compare
Listed as
St. Joseph's HospiceCCN 241546 · All quality measures
Ownership
Non-Profit
Certified
Dec 16, 1994
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D0869495CHI St Joseph's Health323 Main Street, Park Rapids, MN 56470Certificate of waiverNov 3, 2026

National Provider Directory

National Provider Directory
Tax ID family
St Josephs Area Health SVCS6 organizations share this tax ID, including this one
Part of
St Josephs Area Health SVCS

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Commonspirit Health Organization, Englewood, CO Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 1996 100%
John R Lageson Individual Corporate DirectorBod Jan 1, 2017
Lloyd H Dean Individual OtherCSH Home Office Administrator Jul 1, 2020
Benjamin Koppelman Individual Corporate OfficerPresident/Ceo Jan 2, 2007
OtherPresident/Ceo Jan 2, 2007
Kurt Hansen Individual Corporate DirectorBod Jul 1, 2017
Deborah Haagenson Individual Corporate DirectorBod Jul 1, 2005
Jay Paul Ross Individual Corporate OfficerTreasurer Jan 30, 2012
W-2 Managing EmployeeCfo / VP of Finance Jan 30, 2012
Kathy Henry Individual Corporate Director Aug 1, 2006
John Warren Individual Corporate Director Jul 1, 2011
Clifford Tweedale Individual Corporate DirectorBod Jul 1, 2017
Christine Broeker Individual Corporate DirectorBod Nov 2, 1984
Bernice M Ebner Individual Corporate DirectorBod May 1, 2019
Bradley Dahn Individual Corporate DirectorBod Feb 5, 2019
Esther Simon Individual Corporate DirectorBod Feb 5, 2019

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 5

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

NPI Registry JSON

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596067200000",
    "number": "1730185000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 PLEASANT AVE S",
            "city": "PARK RAPIDS",
            "state": "MN",
            "postal_code": "564701431",
            "telephone_number": "218-732-4552",
            "fax_number": "218-732-1273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 MAIN AVE S",
            "city": "PARK RAPIDS",
            "state": "MN",
            "postal_code": "564701550",
            "telephone_number": "218-732-4552",
            "fax_number": "218-732-1273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOSEPH'S AREA HEALTH SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. JOSEPH'S AREA HEALTH SERVICES",
        "enumeration_date": "2005-06-22",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "status": "A",
        "authorized_official_last_name": "KOPPELMAN",
        "authorized_official_first_name": "BEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "218-616-3500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MN",
            "license": "325631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "365324200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Joseph's Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. Joseph's Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Park Rapids, MN

Sources for this page

Verify at the official NPI Registry.