NPIMap

Organization Active NPI

Open Door Health Center

  • Federally Qualified Health Center (FQHC)
  • Mankato, MN
National Provider Identifier
1891740908
Registry record updated Jul 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
OPEN DOOR HEALTH CENTER
Practice address
309 Holly LN
Mankato, MN 56001-5422
Phone
(507) 388-2120
Fax
(507) 388-3924
NPI assigned
May 24, 2006
Last updated
Jul 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2024

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

Authorized official

Name
Jennifer L Beckius
Title
Cfo
Phone
(507) 344-5507

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

309 Holly LN
Mankato, MN 56001-5422

Mailing address

309 Holly LN
Mankato, MN 56001-5422
Phone (507) 388-2120

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070717000563 MN Part A Provider - Federally Qualified Health Center (FQHC) 7012944085 Practice locations: Mankato, MN
O20150930001410 MN Part B Supplier - Clinic/Group Practice 7012944085 Receives reassigned benefits from 23 practitioners
2 other NPIs on this enrollment
Practice locations: Mankato, MN; Shakopee, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891740908. Details of each certification follow.

Federally qualified health center certification: CCN 241857

Legal name
OPEN DOOR HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 8, 2007
Last certification
Aug 8, 2007
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Oct 5, 1983 in MN
Enrollment address
309 Holly LN
Mankato, MN 56001-5422

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Open Door Health Center7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

309 Holly Ln
Ste 101
Mankato, MN 56001
Phone (507) 388-2120

Interoperability endpoints

  • Direct secure messaging: angelaristau@odhc.allscriptsdirect.net
  • Direct secure messaging: colemanstraiton@odhc.allscriptsdirect.net
  • Direct secure messaging: coriwasz@odhc.allscriptsdirect.net
  • Direct secure messaging: emilyfett@odhc.allscriptsdirect.net
  • Direct secure messaging: jennifermurphy@odhc.allscriptsdirect.net
  • Direct secure messaging: melissaheinonen@odhc.allscriptsdirect.net
  • Direct secure messaging: myracolakovic@odhc.allscriptsdirect.net
  • Direct secure messaging: radhakrishnakumar@odhc.allscriptsdirect.net
  • Direct secure messaging: rebeccagruber@odhc.allscriptsdirect.net

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
Jackie Craig Individual Corporate Director Apr 1, 2024
Jennifer Beckius Individual Corporate Director Aug 13, 2018
W-2 Managing Employee Aug 13, 2018
John David Brady Individual Corporate Director Jun 1, 2020
Megan Davis Individual Corporate Director May 1, 2024
Kelly Kenley Individual Corporate Director Apr 18, 2024
Kristeen Giese Individual Corporate Director Feb 1, 2022
Khalil Massad Individual Corporate Director Feb 1, 2022
Jeremy Dean Berger Individual Corporate Director Jun 1, 2022
Selcen Gokdogan Akkoc Individual Corporate Director Feb 1, 2024
Cynthia Trevino Individual Corporate Director Jan 1, 2024
Sherry Caplan Individual Corporate Director Feb 1, 2020

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720396800000",
    "number": "1891740908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 HOLLY LN",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560015422",
            "telephone_number": "507-388-2120",
            "fax_number": "507-388-3924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 HOLLY LN",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560015422",
            "telephone_number": "507-388-2120",
            "fax_number": "507-388-3924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPEN DOOR HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "status": "A",
        "authorized_official_last_name": "BECKIUS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "507-344-5507"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mankato, MN

Sources for this page

Verify at the official NPI Registry.