NPIMap

Organization Active NPI

Sibley Medical Center

Doing business as Ridgeview Gaylord Clinic

  • Rural Health Clinic/Center
  • Gaylord, MN
National Provider Identifier
1871553289
Registry record updated Apr 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SIBLEY MEDICAL CENTER
Doing business as
Ridgeview Gaylord Clinic
Practice address
660 3Rd Street
Gaylord, MN 55334
Phone
(507) 237-5523
Fax
(507) 237-3145
NPI assigned
Mar 28, 2006
Last updated
Apr 20, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2022

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

Authorized official

Name
Michael Phelps
Title
Presient/Ceo
Phone
(952) 442-2191

Specialties & licenses 1

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

Addresses

Primary practice location

660 3Rd Street
Gaylord, MN 55334

Mailing address

601 W Chandler St
P.O. Box 620
Arlington, MN 55307-2127
Phone (507) 964-2271

Other identifiers 1

IdentifierTypeStateIssuer
420628200MedicaidMN

Other names 1

  • Ridgeview Gaylord Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140203000184 MN Part A Provider - Rural Health Clinic 3870722499 Practice locations: Gaylord, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871553289. Details of each certification follow.

Rural health clinic certification: CCN 243429

Legal name
SIBLEY MEDICAL CENTER
Doing business as
RIDGEVIEW GAYLORD CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 1, 2003
Last certification
May 21, 2013
Ownership / control type
2B
Most recent change of ownership
Jan 1, 2014 (1 total)
Organization structure
OtherNon-profit
Incorporated
Mar 24, 1983 in MN
Enrollment address
660 3Rd St
Gaylord, MN 55334-2297
Related CCNs
241311

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

Other NPIs with the same Medicare PAC ID 4

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

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
24D0665083Ridgeview Gaylord Clinic660 3Rd Street West, Gaylord, MN 55334AccreditationMar 29, 2028

National Provider Directory

National Provider Directory
Tax ID family
Sibley Medical Center5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Sheri Kumar Individual Corporate DirectorBoard Director Jan 1, 2026
Acacia Meis Individual W-2 Managing EmployeeCredentialing Manager Jun 6, 2022
Diane Bias-Mosel Individual Corporate Director Jan 1, 2018
Kelly Pierson Individual Corporate DirectorBoard Member Jan 1, 2024
Christopher Bielke Individual W-2 Managing EmployeeManager of Payer Strategy Jun 20, 2022
Ben C Nielsen Individual Corporate OfficerChief Operating Officer Jun 1, 2018
W-2 Managing EmployeeChief Operating Officer Jun 1, 2018
Michael J Phelps Individual Corporate OfficerCeo Jan 1, 2014
Jeffrey T Nelson Individual Corporate DirectorBoard Member Jan 1, 2023
Nancy Mathwig Individual Corporate DirectorBoard Member Jan 1, 2023
Bertha Woehler Individual Corporate DirectorBoard Member Jan 1, 2023
Brent K Wordelman Individual Corporate OfficerChief Financial Officer Oct 1, 2020
W-2 Managing Employee Oct 1, 2020
James Kreft Individual Corporate DirectorBoard Member Jan 1, 2023
Aaron a Bloomquist Individual Corporate OfficerCfo Oct 1, 2002
W-2 Managing Employee Oct 1, 2020
Ridgeview Medical Center Organization, Waconia, MN Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2014 100%

Owners & managing parties with NPI records 6

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

Facilities with the same owner 6

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

NPI Registry JSON

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

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650412800000",
    "number": "1871553289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 W CHANDLER ST",
            "address_2": "P.O. BOX 620",
            "city": "ARLINGTON",
            "state": "MN",
            "postal_code": "553072127",
            "telephone_number": "507-964-2271",
            "fax_number": "507-964-8490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "660 3RD STREET",
            "city": "GAYLORD",
            "state": "MN",
            "postal_code": "55334",
            "telephone_number": "507-237-5523",
            "fax_number": "507-237-3145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIBLEY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-28",
        "last_updated": "2022-04-20",
        "certification_date": "2022-04-20",
        "status": "A",
        "authorized_official_last_name": "PHELPS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIENT/CEO",
        "authorized_official_telephone_number": "952-442-2191"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420628200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ridgeview Gaylord Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ridgeview Gaylord Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gaylord, MN

Sources for this page

Verify at the official NPI Registry.