NPIMap

Organization Active NPI

Cooperstown Medical Center

Doing business as Dakota Regional Medical Center

  • Rural Health Clinic/Center
  • Lakota, ND
National Provider Identifier
1821760679
Registry record updated Feb 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
COOPERSTOWN MEDICAL CENTER
Doing business as
Dakota Regional Medical Center
Dakota Regional Medical Center Lakota RHC
Practice address
117 2ND St W
Lakota, ND 58344-7320
Phone
(701) 786-1700
Fax
(701) 786-7121
NPI assigned
Sep 30, 2021
Last updated
Feb 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2024

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

Authorized official

Name
Kelley Shawn
Title
Admin Assist/Credentialing
Phone
(701) 786-1709

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

117 2ND St W
Lakota, ND 58344-7320

Mailing address

107 12TH St S
Cooperstown, ND 58425-4501
Phone (701) 786-1709

Other names 2

  • Dakota Regional Medical Center Doing business as
  • Dakota Regional Medical Center Lakota RHC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211111000529 ND Part A Provider - Rural Health Clinic 5698687689 Practice locations: Lakota, ND

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821760679. Details of each certification follow.

Rural health clinic certification: CCN 358511

Legal name
COOPERSTOWN MEDICAL CENTER
Doing business as
DAKOTA REGIONAL MEDICAL CTR-LAKOTA
Certification status
Terminated Voluntary: merger or closure, Dec 31, 2025
Provider type (POS)
Rural health clinic
Participating since
Aug 15, 2022
Last certification
Jul 27, 2022
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Dec 17, 1946 in ND
Enrollment address
139 2ND St W
Lakota, ND 58344
Related CCNs
351306

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).

National Provider Directory

National Provider Directory
Tax ID family
Cooperstown Medical Center4 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 8

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

NameRoleSinceShare
Barry Getz Individual Corporate DirectorBoard President Apr 19, 2022
Gerald Stokka Individual Corporate DirectorBoard Vice President Dec 29, 2021
Benjamin Halvorson Individual Corporate DirectorDirector Apr 19, 2022
James Halvorson Individual Corporate DirectorDirector Dec 30, 2020
Larry Grandalen Individual Corporate DirectorDirector Apr 19, 2022
Cooperstown Medical Center Organization, Cooperstown, ND Corporation, Non-profit 5% Or Greater Direct Ownership Interest Oct 15, 2021 100%
Operational/Managerial Control Oct 15, 2021 100%
Nicole Johnson Individual Corporate OfficerChief Executive Officer Feb 1, 2014
W-2 Managing EmployeeAdministrator/Ceo Feb 1, 2014
Operational/Managerial ControlAdministrator/Ceo Aug 15, 2013
Barbara Anderson Individual Corporate OfficerCfo Feb 5, 2014

Owners & managing parties with NPI records 4

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

  • Cooperstown Medical Center

    dba Cooperstown Medical Center Critical Access Hospital

    • Critical Access Hospital
    • Cooperstown, ND
    • NPI 1235239229

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Cooperstown Medical Center

    dba Cooperstown Medical Center Swing Bed

    • Medicare Defined Swing Bed Hospital Unit
    • Cooperstown, ND
    • NPI 1376635151

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Cooperstown Medical Center

    dba CMC Rural Health Clinic

    • Rural Health Clinic/Center
    • Cooperstown, ND
    • NPI 1962548214

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Cooperstown Medical Center

    dba DRMC New Rockford RHC

    • Rural Health Clinic/Center
    • New Rockford, ND
    • NPI 1992459721

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Dakota Regional Medical Center Hospital SwingbedCooperstown, ND, CCN 35Z306 Hospital Operational/Managerial Control Jan 21, 2009
Cooperstown Medical CenterNew Rockford, ND, CCN 358514 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 1, 2022
Aug 1, 2022

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1632960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708387200000",
    "number": "1821760679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 12TH ST S",
            "city": "COOPERSTOWN",
            "state": "ND",
            "postal_code": "584254501",
            "telephone_number": "701-786-1709",
            "fax_number": "701-786-7121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 2ND ST W",
            "city": "LAKOTA",
            "state": "ND",
            "postal_code": "583447320",
            "telephone_number": "701-786-1700",
            "fax_number": "701-786-7121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOPERSTOWN MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-30",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-19",
        "status": "A",
        "authorized_official_last_name": "SHAWN",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_title_or_position": "ADMIN ASSIST/CREDENTIALING",
        "authorized_official_telephone_number": "701-786-1709"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dakota Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dakota Regional Medical Center Lakota RHC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakota, ND

Sources for this page

Verify at the official NPI Registry.