NPIMap

Organization Active NPI

Johnson Memorial Health Services

Doing business as Johnson Memorial Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Dawson, MN
National Provider Identifier
1770697260
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
331041 Issued in MN
Legal business name
JOHNSON MEMORIAL HEALTH SERVICES
Doing business as
Johnson Memorial Hospital
Practice address
1282 Walnut St
Dawson, MN 56232-2333
Phone
(320) 769-4323
Fax
(320) 769-2131
NPI assigned
Aug 19, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Glenn Haugo
Title
Administrator
Phone
(320) 769-4323

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 331041 MN Primary

Addresses

Primary practice location

1282 Walnut St
Dawson, MN 56232-2333

Mailing address

1282 Walnut St
Dawson, MN 56232-2333
Phone (320) 769-4323

Other identifiers 1

IdentifierTypeStateIssuer
808845400MedicaidMN

Other names 1

  • Johnson Memorial Hospital Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031223000327 MN Part B Supplier - Clinic/Group Practice 5395653836 Receives reassigned benefits from 32 practitioners
2 other NPIs on this enrollment
Practice locations: Boyd, MN; Dawson, MN
O20070904000462 MN Part A Provider - Critical Access Hospital 5395653836 Receives reassigned benefits from 3 practitioners
Practice locations: Dawson, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770697260. Details of each certification follow.

Hospital certification: CCN 24Z314

Legal name
JOHNSON MEMORIAL HEALTH SERVICES
Doing business as
JOHNSON MEMORIAL HOSPITAL
Organization structure
GovernmentNon-profit
Incorporated
Nov 21, 1972 in MN
Enrollment address
1282 Walnut St
Dawson, MN 56232-2333
Hospital Swing-Bed Unit

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

Other NPIs with the same Medicare PAC ID 4

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.

National Provider Directory

National Provider Directory
Tax ID family
Dawson Clinic4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Johnson Memorial Health Services Organization, Dawson, MN Other Nov 21, 1972 100%
Crystal Bothun Individual W-2 Managing EmployeeCfo Aug 7, 2024
Jacob William Redepenning Individual W-2 Managing EmployeeAd; Nov 18, 2024

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Johnson Memorial HospitalDawson, MN, CCN 241314 Hospital Other (100%) Nov 21, 1972
Johnson Memorial Nursing HomeDawson, MN, CCN 245485 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jun 6, 1972
Boyd ClinicBoyd, MN, CCN 243426 Rural health clinic Operational/Managerial Control (100%) Nov 21, 1972
Dawson ClinicDawson, MN, CCN 243979 Rural health clinic Other (100%) Nov 21, 1972

Owned or controlled facilities with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 37

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 37

Affiliated clinicians 2

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": "1155945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770697260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1282 WALNUT ST",
            "city": "DAWSON",
            "state": "MN",
            "postal_code": "562322333",
            "telephone_number": "320-769-4323",
            "fax_number": "320-769-2131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1282 WALNUT ST",
            "city": "DAWSON",
            "state": "MN",
            "postal_code": "562322333",
            "telephone_number": "320-769-4323",
            "fax_number": "320-769-2131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNSON MEMORIAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HAUGO",
        "authorized_official_first_name": "GLENN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "320-769-4323"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "MN",
            "license": "331041",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "808845400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Johnson Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dawson, MN

Sources for this page

Verify at the official NPI Registry.