Gateway Family Health Clinic, LTD.
Organization Active NPI Rural Health Clinic/Center · Sandstone, MN
NPI 1790772259 · NPPES record last updated May 13, 2025
Key facts
- NPI
- 1790772259
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 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
- Organization subpart
- No
Authorized official
- Name
- Mr. Eric P. Nielsen
- Title
- Administrator
- Phone
- (218) 485-4491
Owners & managing parties with NPI records 11
-
Kathy H. Brandli, M.D.
-
Raymond G. Christensen, M.D.
-
Bridget M. Dewey, M.D.
-
Paul R. Dewey, M.D.
-
Ryan Mark Harden, M.D.
-
Dania A. Kamp, M.D.
-
Mark H Petry, M.D.
-
Randy J. Rice, M.D.
-
Steve S. Tekippe, M.D.
-
Christopher N. Thiessen, M.D.
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 1
Practitioners 20
-
Gary T. Anderson, F.N.P.
-
Kathy H. Brandli, M.D.
-
Raymond G. Christensen, M.D.
-
Bridget M. Dewey, M.D.
-
Paul R. Dewey, M.D.
-
Ryan Mark Harden, M.D.
-
Dania A. Kamp, M.D.
-
Amanda R Manley, LMFT
-
Mark H Petry, M.D.
-
Randy J. Rice, M.D.
-
Sonja M. Roach, N.P.
-
Steve S. Tekippe, M.D.
-
Christopher N. Thiessen, M.D.
-
Anna Marie Bedogne, D.C.
-
Brian K. Barstad, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 24D0935435 | Gateway Family Health Clinic, LTD | Accreditation | Mar 17, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
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
- Corporation · Proprietary
- Incorporated
- Mar 26, 1973 in MN
- Enrollment address
- 707 Lundorff Dr
Ste 1
Sandstone, MN 55072-5099
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Mark Harold Petry |
5% Or Greater Direct Ownership Interest |
Jun 1, 2010 | 9.09% |
| General Partnership Interest |
Jun 1, 2010 | 9.09% | |
| Corporate Officer |
Jan 1, 2017 | 9.09% | |
| W-2 Managing Employee |
Jun 1, 2010 | 9.09% | |
| Christopher N Thiessen |
5% Or Greater Direct Ownership Interest |
Apr 1, 2003 | 9.09% |
| General Partnership Interest |
Apr 1, 2003 | 9.09% | |
| Corporate Director |
Jan 1, 2017 | 9.09% | |
| W-2 Managing Employee |
Apr 1, 2003 | 9.09% | |
| Dania a Kamp |
5% Or Greater Direct Ownership Interest |
Feb 1, 2006 | 9.09% |
| General Partnership Interest |
Feb 1, 2006 | 9.09% | |
| Corporate Officer |
Jan 1, 2018 | ||
| Corporate Director |
Aug 30, 2004 | ||
| W-2 Managing Employee |
Feb 1, 2006 | 9.09% | |
| Eric Nielsen |
W-2 Managing Employee | Mar 24, 2008 | |
| Bridget Margaret Dewey |
5% Or Greater Direct Ownership Interest |
Feb 1, 2003 | 9.09% |
| General Partnership Interest |
Feb 1, 2003 | 9.09% | |
| W-2 Managing Employee |
Feb 1, 2003 | 9.09% | |
| Randy J Rice |
5% Or Greater Direct Ownership Interest |
Jan 1, 2008 | 9.09% |
| General Partnership Interest |
Jan 1, 2008 | 9.09% | |
| Corporate Director |
Jul 31, 2006 | ||
| W-2 Managing Employee |
Jan 1, 2008 | 9.09% | |
| Kathy Helene Brandli |
5% Or Greater Direct Ownership Interest |
Jun 1, 2008 | 9.09% |
| General Partnership Interest |
Jun 1, 2008 | 9.09% | |
| W-2 Managing Employee |
Jun 8, 2008 | 9.09% | |
| Steve S Tekippe |
5% Or Greater Direct Ownership Interest |
Jan 1, 1997 | 9.09% |
| General Partnership Interest |
Jan 1, 1997 | 9.09% | |
| Corporate Director |
Sep 1, 1995 | ||
| W-2 Managing Employee |
Jan 1, 1997 | 9.09% | |
| Maggie B Neudecker |
Corporate Officer |
Jan 1, 2022 | |
| Corporate Director |
Oct 1, 2013 | ||
| W-2 Managing Employee |
Oct 1, 2015 | 9.09% | |
| Ryan M Harden |
5% Or Greater Direct Ownership Interest |
Jan 1, 2012 | 9.09% |
| General Partnership Interest |
Jan 1, 2012 | 9.09% | |
| W-2 Managing Employee |
Jan 1, 2012 | 9.09% | |
| Paul Robert Dewey |
5% Or Greater Direct Ownership Interest |
Feb 1, 2003 | 9.09% |
| General Partnership Interest |
Feb 1, 2003 | 9.09% | |
| Corporate Director |
Jan 1, 2020 | ||
| W-2 Managing Employee |
Feb 1, 2003 | 9.09% | |
| Raymond G Christensen |
W-2 Managing Employee | Apr 11, 1973 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Locations
206 Main St E
Hinckley, MN 55037
Phone (320) 384-6618
707 Lundorff Dr
Sandstone, MN 55072
Phone (320) 245-2250
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist |
106H00000X | |||
| Chiropractor |
111N00000X | |||
| Family Medicine Physician |
207Q00000X | |||
| Internal Medicine Physician |
207R00000X | |||
| Pediatrics Physician |
208000000X | |||
| General Practice Physician |
208D00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes | ||
| Physician Assistant |
363A00000X | |||
| Family Nurse Practitioner |
363LF0000X | |||
| Certified Registered Nurse Anesthetist |
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
Other providers in Sandstone, MN
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- Kimberly June Fletcher
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- James Richard Franzel
- Peggy Ann Frisch
- Marita Watrin Haberman
- Andrea Jean Hanson
- Daniel Quade Hanson
- Ryan Mark Harden
- Jeffrey John Haskamp
All providers in Sandstone, MN · Rural Health Clinic/Center in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.