NPIMap

Organization Active NPI

Ashley Medical Center

Doing business as AMC Clinic

  • Clinic/Center
  • Ashley, ND
National Provider Identifier
1851335830
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
ASHLEY MEDICAL CENTER
Doing business as
AMC Clinic
Practice address
612 Center Ave N
Ashley, ND 58413-7013
Phone
(701) 288-3448
Fax
(701) 288-3213
NPI assigned
Jun 16, 2006
Last updated
Aug 13, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

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

Authorized official

Name
Mr. Eric Heupel
Title
Administrator/Ceo
Phone
(701) 288-3433

Specialties & licenses 2

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

Addresses

Primary practice location

612 Center Ave N
Ashley, ND 58413-7013

Mailing address

PO Box 450
612 Center Ave N
Ashley, ND 58413-0450
Phone (701) 288-3448

Other identifiers 1

IdentifierTypeStateIssuer
16578MedicaidND

Other names 1

  • AMC Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040423001213 ND Part B Supplier - Clinic/Group Practice 8628981834 Receives reassigned benefits from 16 practitioners
2 other NPIs on this enrollment
Practice locations: Ashley, ND; Zeeland, ND
O20040622000837 ND Part A Provider - Rural Health Clinic 8628981834 Practice locations: Ashley, ND

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1851335830. Details of each certification follow.

Rural health clinic certification: CCN 353423

Legal name
ASHLEY MEDICAL CENTER
Doing business as
AMC CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 22, 1997
Last certification
Feb 2, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Aug 10, 1949 in ND
Enrollment address
612 Center Ave N
Ashley, ND 58413-7013
Related CCNs
351322

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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 2

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
35D1010366AMC Clinic612 Center Ave N, Ashley, ND 58413Certificate of waiverMar 11, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Adam Wishek Individual Corporate Director Oct 17, 2022 10%
Kristie Morrison Individual Corporate Director Oct 17, 2022 10%
Polly L Wyrick-Ulrich Individual Corporate OfficerVice President Nov 1, 2015 10%
Candice Nies Individual Corporate Director Nov 1, 2015 10%
Brenda M Meyer Individual Corporate Director Nov 1, 2016 10%
Anthony Neu Individual Corporate Director Oct 16, 2017 10%
Joanne M Stugelmayer Individual Corporate Director May 20, 2019 10%
Eric J Heupel Individual Corporate OfficerAdminister/Ceo Apr 15, 2019
Corporate Director Apr 15, 2019 10%
W-2 Managing EmployeeAdministrator/Ceo Apr 15, 2019
Jerry L Lepp Individual Corporate OfficerCfo Jan 30, 2017
W-2 Managing EmployeeCfo Apr 2, 1992
Megan Thomas Individual Corporate Director Oct 19, 2020 10%
Shane Peacock Individual Corporate Director Oct 17, 2022 10%

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Ashley Medical CenterAshley, ND, CCN 35Z322 Hospital Operational/Managerial Control Feb 13, 2001

Owned or controlled facilities with NPI records 1

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

  • Ashley Medical Center

    dba Ashley Medical Center Swingbed

    • Medicare Defined Swing Bed Hospital Unit
    • Ashley, ND
    • NPI 1649374042

    Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723507200000",
    "number": "1851335830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 450",
            "address_2": "612 CENTER AVE N",
            "city": "ASHLEY",
            "state": "ND",
            "postal_code": "584130450",
            "telephone_number": "701-288-3448",
            "fax_number": "701-288-3213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 CENTER AVE N",
            "city": "ASHLEY",
            "state": "ND",
            "postal_code": "584137013",
            "telephone_number": "701-288-3448",
            "fax_number": "701-288-3213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASHLEY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-16",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-12",
        "status": "A",
        "authorized_official_last_name": "HEUPEL",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "ADMINISTRATOR/CEO",
        "authorized_official_telephone_number": "701-288-3433",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "ND",
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "16578",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AMC Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ashley, ND

Sources for this page

Verify at the official NPI Registry.