NPIMap

Organization Active NPI

Altru Health System

  • Clinic/Center
  • Grand Forks, ND
National Provider Identifier
1811617103
Registry record updated Nov 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
ALTRU HEALTH SYSTEM
Practice address
4401 S 11TH St Ste 1000
Grand Forks, ND 58201-7238
Phone
(701) 780-7620
NPI assigned
Aug 29, 2022
Last updated
Nov 18, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
ALTRU HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 18, 2025

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

Authorized official

Name
Derek Goebel
Title
Chief Financial Officer
Phone
(701) 780-1470

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

4401 S 11TH St Ste 1000
Grand Forks, ND 58201-7238

Mailing address

PO Box 860939
Minneapolis, MN 55486-0939

Other names 1

  • Sanny and Jerry Ryan Center for Prevention and Genetics Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230315001460 ND MDPP Supplier - in-Person MDPP Supplier 1355251604 Practice locations: Grand Forks, ND

Other NPIs with the same Medicare PAC ID 13

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

View all 13

National Provider Directory

National Provider Directory
Tax ID family
Physicians Associates M24 organizations share this tax ID, including this one
Part of
Physicians Associates M

Other organizations with this tax ID 23

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

View all 23

Ownership & related parties

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Altru Rehabilitation HospitalGrand Forks, ND, CCN 353027 Hospital 5% Or Greater Direct Ownership Interest (40%) May 24, 2021
Valley Senior Living on ColumbiaGrand Forks, ND, CCN 355067 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jun 1, 1994
May 21, 2025
Woodside VillageGrand Forks, ND, CCN 355112 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jun 1, 1994
May 21, 2025
Altru's Home HealthGrand Forks, ND, CCN 357014 Home health agency 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1997

Owned or controlled facilities with NPI records 4

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": "1661731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763424000000",
    "number": "1811617103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860939",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554860939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 S 11TH ST STE 1000",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582017238",
            "telephone_number": "701-780-7620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTRU HEALTH SYSTEM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALTRU HEALTH SYSTEM",
        "enumeration_date": "2022-08-29",
        "last_updated": "2025-11-18",
        "certification_date": "2025-11-18",
        "status": "A",
        "authorized_official_last_name": "GOEBEL",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "701-780-1470"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sanny and Jerry Ryan Center for Prevention and Genetics",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Sanny and Jerry Ryan Center for Prevention and Genetics",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Grand Forks, ND

Sources for this page

Verify at the official NPI Registry.