NPIMap

Organization Active NPI

Sidney Health Center

Doing business as Mon Dak Family Clinic

  • Rural Health Clinic/Center
  • Fairview, MT
National Provider Identifier
1730252883
Registry record updated Dec 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SIDNEY HEALTH CENTER
Doing business as
Mon Dak Family Clinic
Practice address
304 S Ellery
Fairview, MT 59221
Phone
(406) 742-5261
Fax
(406) 742-5263
NPI assigned
Nov 16, 2006
Last updated
Dec 8, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2020

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

Authorized official

Name
Tina Montgomery
Title
Senior Executive, Finiance/Cfo
Phone
(406) 488-2117

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

304 S Ellery
Fairview, MT 59221

Mailing address

214 14TH Ave SW
Suite 107
Sidney, MT 59270
Phone (406) 488-2169

Other identifiers 2

IdentifierTypeStateIssuer
0720161MedicaidMT
63062OtherMTBLUE CROSS

Other names 1

  • Mon Dak Family Clinic Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sanford_toc1008865@direct.sanfordhealth.org Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060417000509 MT Part A Provider - Rural Health Clinic 0749181535 Practice locations: Fairview, MT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730252883. Details of each certification follow.

Rural health clinic certification: CCN 273978

Legal name
SIDNEY HEALTH CENTER
Doing business as
MONDAK CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 2, 1992
Last certification
Jun 24, 2025
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jul 2, 1992 in MT
Enrollment address
304 S Ellery Ave
Fairview, MT 59221-7210
Related CCNs
271344

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

Other NPIs with the same Medicare PAC ID 5

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

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
27D0409780Mondak Family Clinic304 South Ellery Avenue, Fairview, MT 59221Provider-performed microscopyAug 9, 2027

National Provider Directory

National Provider Directory
Tax ID family
Community Meml HSP ER S9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

214 14th Ave SW
Ste 107
Sidney, MT 59270
Phone (406) 488-2169

Ownership & related parties

All disclosed owners & managing parties 26

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

NameRoleSinceShare
Jennifer Mercer Individual W-2 Managing EmployeeSr Executive, Cancer Care Services Oct 27, 2019
Amber Seitzinger Individual W-2 Managing EmployeeChief Operating Officer Nov 17, 2025
Pamela McGlothlin Individual W-2 Managing EmployeeSenior Executive, Nursing Services Jun 7, 2020
Jennifer Roth Individual W-2 Managing EmployeeRevenue Cycle Director Jan 1, 2016
Rita Steinbeisser Individual W-2 Managing EmployeeSenior Executive, Marketing Sep 18, 1998
Lisa Rene Ross Individual Corporate DirectorVoting Medical Staff Rep-Board Jan 22, 2025
Kerry Reitz Individual W-2 Managing EmployeeSr Exect Extendedcare/Administrator Aug 7, 2017
Jennifer Doty Individual Corporate OfficerChief Executive Officer Jun 1, 2018
W-2 Managing EmployeeChief Executive Officer Jun 1, 2018
Cheryl Vanevery Individual Corporate DirectorDirector-Board of Directors Nov 16, 2016
Stephanie Livers Individual Corporate DirectorDirector-Board of Directors Nov 14, 2018
Robert Breuer Individual Corporate DirectorDirector-Board of Directors Nov 20, 2024
Destini Miller Individual W-2 Managing EmployeeHim Director Jun 24, 2024
Deborah Harris Individual Corporate DirectorNon-Voting Medical Staff Rep-Board Nov 20, 2024
Nicole Keysor Individual W-2 Managing EmployeeSr. Executive, Hospital Services Jan 5, 2026
Mike Weber Individual Corporate OfficerDirector-Board of Directors Nov 15, 2024
Susan Duffey Individual Corporate DirectorSecretary-Board of Directors Nov 16, 2022
Eric Beeken Individual Corporate DirectorVice President-Board of Directors Nov 17, 2021
Kelley Wolff Individual W-2 Managing EmployeeInsurance Enrollment Specialist Oct 17, 2022
Rebecca Cassidy Individual W-2 Managing EmployeeSr Executive, Community Services Aug 31, 2018
Matthew Weber Individual W-2 Managing EmployeeSr Executive, Finance May 23, 2025
Tina Montgomery Individual Corporate OfficerChief Financial Officer Aug 6, 2000
W-2 Managing EmployeeChief Financial Officer Aug 6, 2000
Rajohn Karanjai Individual Contracted Managing EmployeeChief Medical Officer Jan 1, 2021
Corporate OfficerChief Medical Officer Jan 1, 2021
Randall Johnson Individual Corporate DirectorDirector-Board of Directors Jun 28, 2006
Robert Burnison Individual Corporate DirectorPresident-Board of Directors Nov 12, 2014
Sean Kavanagh Individual W-2 Managing EmployeeChief Information Officer Mar 11, 2019
Jeri Chapman Individual W-2 Managing EmployeeSr Executive, Human Resources May 23, 2025

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Sidney Health CenterSidney, MT, CCN 271344 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Sidney Health CenterSidney, MT, CCN 27Z344 Hospital 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2007
Sidney Health Center Extended CareSidney, MT, CCN 275121 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Direct Ownership Interest (100%)		 Jun 28, 1996
Feb 6, 1988
Jun 28, 1996

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607385600000",
    "number": "1730252883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 14TH AVE SW",
            "address_2": "SUITE 107",
            "city": "SIDNEY",
            "state": "MT",
            "postal_code": "59270",
            "telephone_number": "406-488-2169",
            "fax_number": "406-488-2149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 S ELLERY",
            "city": "FAIRVIEW",
            "state": "MT",
            "postal_code": "59221",
            "telephone_number": "406-742-5261",
            "fax_number": "406-742-5263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIDNEY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2020-12-08",
        "certification_date": "2020-12-08",
        "status": "A",
        "authorized_official_last_name": "MONTGOMERY",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "SENIOR EXECUTIVE, FINIANCE/CFO",
        "authorized_official_telephone_number": "406-488-2117"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0720161",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "63062",
            "state": "MT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sanford_toc1008865@direct.sanfordhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "304 S Ellery",
            "city": "Fairview",
            "state": "MT",
            "country_code": "US",
            "postal_code": "59221",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Mon Dak Family Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mon Dak Family Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairview, MT

Sources for this page

Verify at the official NPI Registry.