NPIMap

Organization Active NPI

St. Alexius Medical Center

  • Rural Health Clinic/Center
  • Washburn, ND
National Provider Identifier
1831267236
Registry record updated Jan 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ST. ALEXIUS MEDICAL CENTER
Practice address
1177 Border LN
Washburn, ND 58577-4102
Phone
(701) 442-3396
Fax
(701) 462-3422
NPI assigned
Dec 1, 2006
Last updated
Jan 4, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
CATHOLIC HEALTH INITIATIVESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 4, 2018

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

Authorized official

Name
Kathy Hanson
Title
Assistant Administrator
Phone
(701) 448-2331

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X ND
Rural Health Clinic/Center 261QR1300X ND Primary

Addresses

Primary practice location

1177 Border LN
Washburn, ND 58577-4102

Mailing address

PO Box 280
Turtle Lake, ND 58575-0280
Phone (701) 448-2331

Other identifiers 2

IdentifierTypeStateIssuer
1455045MedicaidND
1455046MedicaidND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031104000146 ND Part B Supplier - Clinic/Group Practice 8426960865 Receives reassigned benefits from 654 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bismarck, ND; Mandan, ND; Minot, ND; Turtle Lake, ND; Washburn, ND
O20100319000654 ND Part A Provider - Rural Health Clinic 8426960865 Practice locations: Washburn, ND

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831267236. Details of each certification follow.

Rural health clinic certification: CCN 353434

Legal name
ST ALEXIUS MEDICAL CENTER
Doing business as
COMMONSPIRIT HEALTH
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 1, 2000
Last certification
Feb 5, 2019
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jun 30, 1999 in ND
Enrollment address
1177 Border LN
Washburn, ND 58577-4102
Related CCNs
351304

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

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Catholic Health Initiatives

Locations

4315 Ottawa St
Bismarck, ND 58503
Phone (402) 717-1255

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Todd Michael Preszler Individual Corporate DirectorBoard Member Jul 1, 2019
Timothy J Bopp Individual Corporate DirectorBoard Member Jul 1, 2018
Stacy Schaffer Individual Corporate DirectorBod Oct 23, 2024
Commonspirit Health Organization, Englewood, CO Corporation, Non-profit 5% Or Greater Direct Ownership Interest Feb 1, 2019 10%
Reed E Reyman Individual Corporate OfficerPresident Dec 19, 2022
Corporate DirectorPresident Dec 19, 2022
Operational/Managerial ControlPresident Dec 19, 2022
Nicole Kunze Individual Corporate DirectorBod Aug 1, 2020
Matt Schanandore Individual Corporate DirectorBod Oct 23, 2024
Syed Shiraz Shiraz Hyder Individual Corporate DirectorBod Jul 1, 2021
John Giese Individual Corporate DirectorBod Chair Jul 1, 2022
Luke B Roller Individual Corporate DirectorBod Oct 23, 2024
Calvin Motika Individual Corporate DirectorBod Oct 23, 2024
Laura J Archuleta Individual Corporate DirectorBod Oct 23, 2024
Mike Weisbeck Individual Corporate DirectorBoard Member Jan 20, 2020
Parveen Suhara Wahab Individual Corporate DirectorBod Oct 23, 2024
Kevin R Dahmen Individual Corporate DirectorBoard of Directors Vice Chair Jul 1, 2019
Rosanne Zastoupil Individual Corporate DirectorBod Jul 1, 2022
St Alexius Medical Center Organization, Bismarck, ND Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jun 30, 1999 90%
Operational/Managerial Control Jun 30, 1999 100%
John Mongeon Individual Corporate DirectorBoard Member Oct 1, 2018
Rosanne Schmidt Individual Corporate DirectorBod Oct 23, 2024

Owners & managing parties with NPI records 19

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

View all 19

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
Garrison Memorial HospitalGarrison, ND, CCN 351303 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1997
CHI St. Alexius Health GarrisonGarrison, ND, CCN 35Z303 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 1, 1990
CHI St. Alexius Health Turtle LakeTurtle Lake, ND, CCN 351304 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 1, 1990
Jul 1, 1990
CHI St. Alexius Health Turtle LakeTurtle Lake, ND, CCN 35Z304 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 30, 1990
Jul 30, 1990
Garrison Memorial HospitalGarrison, ND, CCN 355115 Skilled nursing facility 5% Or Greater Direct Ownership Interest Jun 22, 1998
Garrison Family ClinicGarrison, ND, CCN 353412 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1997

Owned or controlled facilities with NPI records 6

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

Facilities with the same owner 6

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

Practitioners & affiliated clinicians

Practitioners 11

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": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1515024000000",
    "number": "1831267236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 280",
            "city": "TURTLE LAKE",
            "state": "ND",
            "postal_code": "585750280",
            "telephone_number": "701-448-2331",
            "fax_number": "701-448-2441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1177 BORDER LN",
            "city": "WASHBURN",
            "state": "ND",
            "postal_code": "585774102",
            "telephone_number": "701-442-3396",
            "fax_number": "701-462-3422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. ALEXIUS MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CATHOLIC HEALTH INITIATIVES",
        "enumeration_date": "2006-12-01",
        "last_updated": "2018-01-04",
        "status": "A",
        "authorized_official_last_name": "HANSON",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "ASSISTANT ADMINISTRATOR",
        "authorized_official_telephone_number": "701-448-2331"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "ND",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "ND",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1455045",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1455046",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Washburn, ND

Sources for this page

Verify at the official NPI Registry.