Mountrail County Medical Center, Inc.
Organization Active NPI Rural Health Clinic/Center · Stanley, ND
NPI 1831289362 · NPPES record last updated Nov 25, 2025
Key facts
- NPI
- 1831289362
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- MOUNTRAIL COUNTY MEDICAL CENTER, INC.
- Practice address
- 615 6TH St SE
Stanley, ND 58784-4444 - Phone
- (701) 628-2505
- Fax
- (701) 628-3990
- NPI assigned
- Oct 13, 2006
- Organization subpart
- No
Authorized official
- Name
- Stephanie Everett
- Title
- Ceo
- Phone
- (701) 628-8603
Owners & managing parties with NPI records 5
Other NPIs with the same Medicare PAC ID 2
Member of 2
Related certifications (CCN) 1
Facilities with the same owner 12
Practitioners 14
-
Tammie M Braaflat, FNP
-
Jessica Charon, FNP-C
-
Brittany Haugtvedt, FNP
-
Carol Elaine Hynek, DNP
-
Jeffrey Alden Moberg Jr., PA-C
-
Tara M Nardacci, N.P.
-
Tara Schaefer-Nygaard, LCSW
-
Shone L Topham, LCSW
-
Rosalyn Marie Geier, DNP
-
Abbey M Ruland, PAC
-
Ann M Welch, FNP-C
-
William Logan Bender, M.D.
-
Antoinette P. Laurel, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in ND, WI
Rural health clinic certification: CCN 353407
- Legal name
- MOUNTRAIL COUNTY MEDICAL CENTER INC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Nov 24, 1993
- Last certification
- Jan 17, 2023
- Ownership / control type
- 2B
- Most recent change of ownership
- Oct 31, 1997 (1 total)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 6, 1997 in ND
- Enrollment address
- 615 6TH St SE
Stanley, ND 58784-4444 - Related CCNs
- 351301
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Stephanie Everett |
Corporate Officer |
Jan 29, 2020 | |
| W-2 Managing Employee | Sep 27, 2013 | ||
| Operational/Managerial Control | Jan 1, 2019 | ||
| Ryan Gjellstad |
Corporate Officer |
Dec 22, 2022 | |
| Corporate Director |
Dec 22, 2022 | ||
| Eugeniya Griffin |
Corporate Officer |
Oct 14, 2023 | |
| W-2 Managing Employee | May 19, 2023 | ||
| Jacob Carpenter |
Corporate Officer |
Dec 4, 2025 | |
| Corporate Director |
Dec 4, 2025 | ||
| Gregory Toepfer |
Corporate Director |
Feb 26, 2026 | |
| Elliot Leinen |
Corporate Director | Jan 23, 2025 | |
| Jamie Eugene Germundson |
Corporate Director |
Nov 21, 2024 | |
| Janel Borud |
W-2 Managing Employee | Aug 21, 1997 | |
| Operational/Managerial Control | Jun 1, 2019 | ||
| Michael Sorenson |
Corporate Officer | Jan 25, 2024 | |
| Corporate Director |
Nov 1, 2014 | 17% | |
| Trinity Health |
5% Or Greater Direct Ownership Interest | Oct 31, 1997 | 50% |
| Operational/Managerial Control | Oct 31, 1997 | 50% | |
| Mountrail Bethel Home Inc |
5% Or Greater Direct Ownership Interest | Oct 31, 1997 | 50% |
| Operational/Managerial Control | Oct 31, 1997 | 50% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040107000468 | ND | Part B Supplier - Clinic/Group Practice | 9739088931 |
Receives reassigned benefits from 13 practitioners Practice locations: Stanley, ND |
| O20101202000101 | ND | Part a Provider - Rural Health Clinic | 9739088931 | Practice locations: Stanley, ND |
| O20250520001668 | WI | Part B Supplier - Clinic/Group Practice | 9739088931 |
Receives reassigned benefits from 1 practitioner Practice locations: Glendale, WI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
615 6TH St SE
Stanley, ND 58784-4444
Mailing address
PO Box 399
Stanley, ND 58784-0399
Phone (701) 628-8602
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12830 | Medicaid | ND | |
| 05057 | Medicaid | ND |
Other providers in Stanley, ND
- Stacey Mae Mortensen
- Mountrail Bethel Home, Inc.
- Mountrail County Medical Center, Inc.
- Mountrail County Medical Center, Inc.
- Mountrail County Medical Center, Inc.
- Mountrail County Social Services
- Zachary Mravec
- Tara M Nardacci
- Heidi Lynn Nielsen
- North Kin Chiropractic PLLC
All providers in Stanley, ND · Rural Health Clinic/Center in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 25, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.