NPIMap

Organization Active NPI

Tioga Medical Center

Doing business as Tioga Medical Center Swingbed

  • Medicare Defined Swing Bed Hospital Unit
  • Tioga, ND
National Provider Identifier
1861463747
Registry record updated Apr 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
5048P Issued in ND
Legal business name
TIOGA MEDICAL CENTER
Doing business as
Tioga Medical Center Swingbed
Practice address
810 N Welo St
Tioga, ND 58852-7157
Phone
(701) 664-3305
Fax
(701) 664-2240
NPI assigned
Jan 30, 2006
Last updated
Apr 22, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
TIOGA MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 22, 2010

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

Authorized official

Name
Randall K Pederson
Title
President/Ceo
Phone
(701) 664-3305

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 5048P ND Primary

Addresses

Primary practice location

810 N Welo St
Tioga, ND 58852-7157

Mailing address

PO Box 159
Tioga, ND 58852-0159
Phone (701) 664-3305

Other identifiers 2

IdentifierTypeStateIssuer
1948MedicaidND
2790OtherNDND BCBSND

Other names 1

  • Tioga Medical Center Swingbed Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080430000676 ND Part A Provider - Critical Access Hospital 1254390305 Receives reassigned benefits from 5 practitioners
Practice locations: Tioga, ND

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861463747. Details of each certification follow.

Hospital certification: CCN 35Z300

Legal name
TIOGA MEDICAL CENTER
Organization structure
CorporationNon-profit
Incorporated
Nov 9, 1953 in ND
Enrollment address
810 N Welo St
Tioga, ND 58852-7157
Hospital Swing-Bed Unit

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

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Tioga Med Ctr Clinic8 organizations share this tax ID, including this one
Part of
Tioga Med Ctr Clinic

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Seth Wisthoff Individual Corporate DirectorDirector Mar 18, 2019
James W Booth Individual Corporate DirectorChairman Mar 20, 2013
Other Apr 1, 2017
Wendy Lenzen Individual Corporate DirectorSecretary/Treasurer Mar 1, 2022
Patrick Joyce Individual Corporate DirectorDirector Mar 20, 2023
Kristopher Kuehn Individual Corporate DirectorDirector Mar 20, 2023
Jeremy Becker Individual Corporate DirectorDirector Apr 1, 2019
Lee a Olson Individual Corporate DirectorDirector Mar 20, 2017
Jamie Eraas Individual Corporate OfficerPresident/Ceo Jan 27, 2023
W-2 Managing EmployeePresident/Ceo Jan 27, 2023
Operational/Managerial ControlPresident/Ceo Jan 27, 2023
Nathan Germundson Individual Corporate DirectorDirector Apr 1, 2020
Brodie Odegaard Individual Corporate DirectorVice-Chairman Mar 20, 2017

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Tioga Medical Center LTCTioga, ND, CCN 355034 Skilled nursing facility Operational/Managerial Control (100%) Jan 1, 1978
Tioga Medical Center - Powers Lake RHCPowers Lake, ND, CCN 353987 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Aug 1, 1990
Aug 1, 1990
Tioga Medical Center-Ray RHCRay, ND, CCN 353988 Rural health clinic Operational/Managerial Control (100%) Apr 15, 1992
Tioga Medical Center-Tioga RHCTioga, ND, CCN 353986 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Aug 1, 1990

Owned or controlled facilities with NPI records 4

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

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.

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271894400000",
    "number": "1861463747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 159",
            "city": "TIOGA",
            "state": "ND",
            "postal_code": "588520159",
            "telephone_number": "701-664-3305",
            "fax_number": "701-664-2240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 N WELO ST",
            "city": "TIOGA",
            "state": "ND",
            "postal_code": "588527157",
            "telephone_number": "701-664-3305",
            "fax_number": "701-664-2240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIOGA MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TIOGA MEDICAL CENTER",
        "enumeration_date": "2006-01-30",
        "last_updated": "2010-04-22",
        "status": "A",
        "authorized_official_last_name": "PEDERSON",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "701-664-3305"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "ND",
            "license": "5048P",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1948",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ND BCBSND",
            "identifier": "2790",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tioga Medical Center Swingbed",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tioga, ND

Sources for this page

Verify at the official NPI Registry.