NPIMap

Organization Active NPI

Gateway Family Health Clinic, LTD.

  • Rural Health Clinic/Center
  • Sandstone, MN
National Provider Identifier
1790772259
Registry record updated May 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GATEWAY FAMILY HEALTH CLINIC, LTD.
Practice address
707 Lundorff Dr Ste 1
Sandstone, MN 55072-5099
Phone
(320) 245-2250
Fax
(320) 245-2555
NPI assigned
Sep 30, 2005
Last updated
May 13, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2025

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

Authorized official

Name
Mr. Eric P. Nielsen
Title
Administrator
Phone
(218) 485-4491

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X
Rural Health Clinic/Center 261QR1300X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X

Addresses

Primary practice location

707 Lundorff Dr Ste 1
Sandstone, MN 55072-5099

Mailing address

4570 Cty Hwy 61
Moose Lake, MN 55767-9401
Phone (218) 485-4491

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031104000556 MN Part B Supplier - Clinic/Group Practice 6305758657 Receives reassigned benefits from 19 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Moose Lake, MN; Sandstone, MN
O20031113000197 MN Part A Provider - Rural Health Clinic 6305758657 Practice locations: Sandstone, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790772259. Details of each certification follow.

Rural health clinic certification: CCN 243859

Legal name
GATEWAY FAMILY HEALTH CLINIC, LTD.
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 28, 2004
Last certification
Sep 8, 2015
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Mar 26, 1973 in MN
Enrollment address
707 Lundorff Dr
Ste 1
Sandstone, MN 55072-5099

Other NPIs with the same Medicare PAC ID 1

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.

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
24D0935435Gateway Family Health Clinic, LTD707 Lundorff Drive Suite 1, Sandstone, MN 55072AccreditationMar 17, 2028

National Provider Directory

National Provider Directory

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

206 Main St E
Hinckley, MN 55037
Phone (320) 384-6618

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Mark Harold Petry Individual 5% Or Greater Direct Ownership InterestAt Large & Board Member Jun 1, 2010 9.09%
General Partnership InterestAt Large & Board Member Jun 1, 2010 9.09%
Corporate OfficerAt Large Jan 1, 2017 9.09%
W-2 Managing EmployeeAt Large & Board Member Jun 1, 2010 9.09%
Christopher N Thiessen Individual 5% Or Greater Direct Ownership InterestPresident & Board Member Apr 1, 2003 9.09%
General Partnership InterestPresident & Board Member Apr 1, 2003 9.09%
Corporate DirectorPresident Jan 1, 2017 9.09%
W-2 Managing EmployeePresident & Board Member Apr 1, 2003 9.09%
Dania a Kamp Individual 5% Or Greater Direct Ownership InterestBoard Member Feb 1, 2006 9.09%
General Partnership InterestBoard Member Feb 1, 2006 9.09%
Corporate OfficerPresident Jan 1, 2018
Corporate DirectorBoard Member Aug 30, 2004
W-2 Managing EmployeeBoard Member Feb 1, 2006 9.09%
Eric Nielsen Individual W-2 Managing Employee Mar 24, 2008
Bridget Margaret Dewey Individual 5% Or Greater Direct Ownership InterestBoard Member Feb 1, 2003 9.09%
General Partnership InterestBoard Member Feb 1, 2003 9.09%
W-2 Managing EmployeeBoard Member Feb 1, 2003 9.09%
Randy J Rice Individual 5% Or Greater Direct Ownership InterestBoard Member Jan 1, 2008 9.09%
General Partnership InterestBoard Member Jan 1, 2008 9.09%
Corporate DirectorBoard Member Jul 31, 2006
W-2 Managing EmployeeBoard Member Jan 1, 2008 9.09%
Kathy Helene Brandli Individual 5% Or Greater Direct Ownership InterestBoard Member Jun 1, 2008 9.09%
General Partnership InterestBoard Member Jun 1, 2008 9.09%
W-2 Managing EmployeeBoard Member Jun 8, 2008 9.09%
Steve S Tekippe Individual 5% Or Greater Direct Ownership InterestBoard Member Jan 1, 1997 9.09%
General Partnership InterestBoard Member Jan 1, 1997 9.09%
Corporate DirectorBoard Member Sep 1, 1995
W-2 Managing EmployeeBoard Member Jan 1, 1997 9.09%
Maggie B Neudecker Individual Corporate OfficerMedical Director Jan 1, 2022
Corporate DirectorBoard Member Oct 1, 2013
W-2 Managing EmployeeBoard Member Oct 1, 2015 9.09%
Ryan M Harden Individual 5% Or Greater Direct Ownership InterestMedical Director & Board Member Jan 1, 2012 9.09%
General Partnership InterestMedical Director & Board Member Jan 1, 2012 9.09%
W-2 Managing EmployeeBoard Member & Medical Director Jan 1, 2012 9.09%
Paul Robert Dewey Individual 5% Or Greater Direct Ownership InterestBoard Member Feb 1, 2003 9.09%
General Partnership InterestBoard Member Feb 1, 2003 9.09%
Corporate DirectorOfficer at Large Jan 1, 2020
W-2 Managing EmployeeBoard Member Feb 1, 2003 9.09%
Raymond G Christensen Individual W-2 Managing Employee Apr 11, 1973

Owners & managing parties with NPI records 11

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

  • Kathy H. Brandli, M.D.
    • Family Medicine Physician
    • Moose Lake, MN
    • NPI 1265467658

    5% Or Greater Direct Ownership Interest, General Partnership Interest, W-2 Managing Employee

    CMS ownership
  • Raymond G. Christensen, M.D.
    • Family Medicine Physician
    • Moose Lake, MN
    • NPI 1902809841

    W-2 Managing Employee

    CMS ownership
  • Bridget M. Dewey, M.D.
    • Internal Medicine Physician
    • Sandstone, MN
    • NPI 1073516647

    5% Or Greater Direct Ownership Interest, General Partnership Interest, W-2 Managing Employee

    CMS ownership
  • Paul R. Dewey, M.D.
    • Internal Medicine Physician
    • Moose Lake, MN
    • NPI 1760485387

    5% Or Greater Direct Ownership Interest, Corporate Director, General Partnership Interest, W-2 Managing Employee

    CMS ownership
  • Ryan Mark Harden, M.D.
    • Family Medicine Physician
    • Sandstone, MN
    • NPI 1295957116

    5% Or Greater Direct Ownership Interest, General Partnership Interest, W-2 Managing Employee

    CMS ownership
  • Dania A. Kamp, M.D.
    • Family Medicine Physician
    • Moose Lake, MN
    • NPI 1386647980

    5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, General Partnership Interest, W-2 Managing Employee

    CMS ownership
  • Maggie Beth Neudecker, MD
    • Family Medicine Physician
    • Moose Lake, MN
    • NPI 1154647071

    Corporate Director, Corporate Officer, W-2 Managing Employee

    CMS ownership
  • Mark H Petry, M.D.
    • Family Medicine Physician
    • Sandstone, MN
    • NPI 1487668034

    5% Or Greater Direct Ownership Interest, Corporate Officer, General Partnership Interest, W-2 Managing Employee

    CMS ownership
  • Randy J. Rice, M.D.
    • Family Medicine Physician
    • Moose Lake, MN
    • NPI 1083652275

    5% Or Greater Direct Ownership Interest, Corporate Director, General Partnership Interest, W-2 Managing Employee

    CMS ownership
  • Steve S. Tekippe, M.D.
    • Family Medicine Physician
    • Moose Lake, MN
    • NPI 1194728733

    5% Or Greater Direct Ownership Interest, Corporate Director, General Partnership Interest, W-2 Managing Employee

    CMS ownership
  • Christopher N. Thiessen, M.D.
    • Family Medicine Physician
    • Moose Lake, MN
    • NPI 1306849914

    5% Or Greater Direct Ownership Interest, Corporate Director, General Partnership Interest, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747094400000",
    "number": "1790772259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4570 CTY HWY 61",
            "city": "MOOSE LAKE",
            "state": "MN",
            "postal_code": "557679401",
            "telephone_number": "218-485-4491",
            "fax_number": "218-485-4724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 LUNDORFF DR STE 1",
            "city": "SANDSTONE",
            "state": "MN",
            "postal_code": "550725099",
            "telephone_number": "320-245-2250",
            "fax_number": "320-245-2555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GATEWAY FAMILY HEALTH CLINIC, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-30",
        "last_updated": "2025-05-13",
        "certification_date": "2025-05-13",
        "status": "A",
        "authorized_official_last_name": "NIELSEN",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "218-485-4491",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandstone, MN

Sources for this page

Verify at the official NPI Registry.