NPIMap

Organization Active NPI

Cuyuna Regional Medical Center

Doing business as Longville Lakes Clinic

  • Family Medicine Physician
  • Longville, MN
National Provider Identifier
1861414518
Registry record updated May 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CUYUNA REGIONAL MEDICAL CENTER
Doing business as
Longville Lakes Clinic
Practice address
180 Jordan Lane
Longville, MN 56655
Phone
(218) 363-3300
Fax
(218) 363-2233
NPI assigned
Jul 24, 2006
Last updated
May 4, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2017

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

Authorized official

Name
Katie Berg
Title
Director of Finance
Phone
(218) 546-7000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

180 Jordan Lane
Longville, MN 56655

Mailing address

320 East Main Street
Crosby, MN 56441
Phone (218) 546-7000

Other identifiers 2

IdentifierTypeStateIssuer
24-3872OtherMNRHC
684513400MedicaidMN

Other names 1

  • Longville Lakes Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040707000501 MN Part B Supplier - Clinic/Group Practice 9537146550 Receives reassigned benefits from 250 practitioners
1 other NPI on this enrollment
Practice locations: Baxter, MN; Crosby, MN
O20081107000037 MN Part A Provider - Rural Health Clinic 9537146550 Practice locations: Longville, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861414518. Details of each certification follow.

Rural health clinic certification: CCN 243466

Legal name
CUYUNA REGIONAL MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 1, 2013
Last certification
Mar 19, 2014
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
May 27, 1992 in MN
Enrollment address
180 Jordan LN
Longville, MN 56655-3164
Related CCNs
241353

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

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 1

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
24D0709280Cuyuna Regional Medical Center - Longville180 Jordan Lane, Longville, MN 56655AccreditationMay 5, 2027

National Provider Directory

National Provider Directory

Locations

180 Jordan Ln
Longville, MN 56655
Phone (218) 336-3300

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Paige E Holmgren Individual Corporate DirectorBoard Member Jan 1, 2022
Andrea Bedard Individual Corporate DirectorBoard Member Aug 1, 2016
Kent Feltz Individual Corporate DirectorBoard Member Jan 1, 2022
Wade Leonard Individual Corporate DirectorBoard Member Jan 1, 2022
Katie J Berg Individual Corporate Officer Aug 1, 2016
Jamie Skjeveland Individual Corporate DirectorBoard Member Jan 1, 2022
Joshua Michael Horowitz Individual Corporate DirectorBoard Member Jan 1, 2022
Amy L Hart Individual W-2 Managing EmployeeCeo Jan 1, 2022 100%
Bart Taylor Individual Corporate DirectorBoard Member Aug 1, 2016

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Cuyuna Regional Medical CenterCrosby, MN, CCN 24Z353 Hospital Operational/Managerial Control (100%) Aug 1, 2016
HeartwoodCrosby, MN, CCN 245232 Skilled nursing facility 5% Or Greater Direct Ownership Interest (50%)
Operational/Managerial Control
Adp of the SNF		 Nov 9, 2022
May 17, 2023
Jan 2, 2025

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 251

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 251

NPI Registry JSON

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493856000000",
    "number": "1861414518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 EAST MAIN STREET",
            "city": "CROSBY",
            "state": "MN",
            "postal_code": "56441",
            "telephone_number": "218-546-7000",
            "fax_number": "218-363-2233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 JORDAN LANE",
            "city": "LONGVILLE",
            "state": "MN",
            "postal_code": "56655",
            "telephone_number": "218-363-3300",
            "fax_number": "218-363-2233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUYUNA REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-24",
        "last_updated": "2017-05-04",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "KATIE",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "218-546-7000"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RHC",
            "identifier": "24-3872",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "684513400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Longville Lakes Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Longville, MN

Sources for this page

Verify at the official NPI Registry.