NPIMap

Organization Active NPI

Pembina County Memorial Hospital Association

  • Critical Access Hospital
  • Cavalier, ND
National Provider Identifier
1760542500
Registry record updated Jul 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
5009B Issued in ND
Legal business name
PEMBINA COUNTY MEMORIAL HOSPITAL ASSOCIATION
Practice address
301 Mountain St E
Cavalier, ND 58220
Phone
(701) 265-8473
Fax
(701) 265-6269
NPI assigned
Dec 11, 2006
Last updated
Jul 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2022

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

Authorized official

Name
Mrs. Lisa R Letexier
Title
Ceo
Phone
(701) 265-6228

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 5009B ND Primary

Addresses

Primary practice location

301 Mountain St E
Cavalier, ND 58220

Mailing address

301 Mountain Street
Cavalier, ND 58220
Phone (701) 265-8473

Other identifiers 1

IdentifierTypeStateIssuer
12113MedicaidND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041006000441 ND Part B Supplier - Clinic/Group Practice 4789643719 Receives reassigned benefits from 15 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cavalier, ND
O20101019001369 ND Part A Provider - Critical Access Hospital 4789643719 Receives reassigned benefits from 3 practitioners
Practice locations: Cavalier, ND

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1760542500. Details of each certification follow.

Hospital certification: CCN 351319

Legal name
PEMBINA COUNTY MEMORIAL HOSPITAL ASSOCIATION
Doing business as
COUNTY MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Oct 1, 2001
Last certification
Jan 5, 2023
Beds
20
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Apr 3, 1946 in ND
Enrollment address
301 Mountain St E
Cavalier, ND 58220-4015
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Pembina County Memorial HospitalCCN 351319 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

301 Mountain St E
Cavalier, ND 58220
Phone (701) 265-6307

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Kulvinder S Sumra Individual Corporate Director Aug 16, 2010
Susan J Thompson Individual Corporate Director Jan 1, 2021
Gordon Johnson Individual Corporate Director Jun 1, 2021
Kenneth F Schwandt Individual Corporate Director Aug 16, 2010
George Wright Individual Corporate Director Jul 1, 2019
Lisa Letexier Individual Corporate OfficerChief Executive Officer Jun 4, 2016
W-2 Managing Employee Jun 1, 2016
Operational/Managerial Control Jun 1, 2016
Thomas Vaughn Individual Corporate DirectorBoard President Aug 16, 2010
Duane Deraas Individual Corporate Director Sep 1, 2018
Nicole Safranski Individual Corporate Director Mar 1, 2016
Katie McDonald Individual Corporate OfficerChief Financial Officer May 3, 2019
W-2 Managing Employee May 30, 2019

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Wedgewood ManorCavalier, ND, CCN 355087 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 1980
Apr 3, 1946

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 12

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.

Affiliated clinicians 64

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

View all 64

NPI Registry JSON

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658707200000",
    "number": "1760542500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 MOUNTAIN STREET",
            "city": "CAVALIER",
            "state": "ND",
            "postal_code": "58220",
            "telephone_number": "701-265-8473",
            "fax_number": "701-265-6269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 MOUNTAIN ST E",
            "city": "CAVALIER",
            "state": "ND",
            "postal_code": "58220",
            "telephone_number": "701-265-8473",
            "fax_number": "701-265-6269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEMBINA COUNTY MEMORIAL HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A",
        "authorized_official_last_name": "LETEXIER",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "701-265-6228",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "ND",
            "license": "5009B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12113",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cavalier, ND

Sources for this page

Verify at the official NPI Registry.