NPIMap

Organization Active NPI

St Mary's Regional Health Center

Doing business as Essentia Health St. Mary's-Frazee Clinic

  • Rural Health Clinic/Center
  • Frazee, MN
National Provider Identifier
1902364482
Registry record updated Mar 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ST MARY'S REGIONAL HEALTH CENTER
Doing business as
Essentia Health St. Mary's-Frazee Clinic
Practice address
300 E Main Ave
Frazee, MN 56544-4504
Phone
(218) 334-7255
Fax
(218) 334-4068
NPI assigned
Mar 4, 2019
Last updated
Mar 1, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ESSENTIA HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 1, 2024

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

Authorized official

Name
Alan Hurley
Title
Coo
Phone
(701) 364-7667

Specialties & licenses 1

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

Addresses

Primary practice location

300 E Main Ave
Frazee, MN 56544-4504

Mailing address

1702 University Dr S
Medical Staff Services-SSC
Fargo, ND 58103-4940
Phone (701) 364-8177

Other names 1

  • Essentia Health St. Mary's-Frazee Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20031117000090 MN Part B Supplier - Clinic/Group Practice 2062326820 Receives reassigned benefits from 290 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Frazee, MN; Lake Park, MN; Mahnomen, MN; Menahga, MN; Park Rapids, MN; Pelican Rapids, MN; Walker, MN; Detroit Lakes, MN
O20060328000559 MN Part A Provider - Hospital 2062326820 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Park Rapids, MN; Walker, MN; Pelican Rapids, MN; Mahnomen, MN; Lake Park, MN; Frazee, MN; Detroit Lakes, MN
O20190411000938 MN Part A Provider - Rural Health Clinic 2062326820 Practice locations: Frazee, MN

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1902364482. Details of each certification follow.

Hospital certification: CCN 240101

Legal name
ST MARYS REGIONAL HEALTH CENTER
Doing business as
ESSENTIA HEALTH ST MARY'S DETROIT LAKES
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jul 18, 1997
Beds
87
Ownership / control type
Church
Organization structure
CorporationNon-profit
Enrollment address
1027 Washington Ave
Detroit Lakes, MN 56501-3409
Other Hospital Practice Location
Hospital subgroups
General

Rural health clinic certification: CCN 243492

Legal name
ST MARYS REGIONAL HEALTH CENTER
Doing business as
ESSENTIA HEALTH ST. MARY'S FRAZEE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 14, 2021
Last certification
Jan 14, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
300 E Main Ave
Frazee, MN 56544-4504
Related CCNs
240101

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

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 13

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

View all 13

Care Compare: Hospital

Medicare Care Compare
Listed as
Essentia Health St Marys - Detroit LakesCCN 240101 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Church
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
St Marys Regional Healt11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

1112 Lincoln Ave
Detroit Lakes, MN 56501
Phone (218) 847-0883

826 Summit Ave
#826
Detroit Lakes, MN 56501
Phone (218) 844-4221

3362 35th Ave S
Fargo, ND 58104
Phone (701) 364-3010

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Stefanie Gefroh Ellison Individual Corporate OfficerPresident Aug 12, 2024
Tim D Heilman Individual Corporate DirectorBoard Member Jan 1, 2020
Corporate DirectorBoard Member Jun 16, 2021
Aarick L Jackson Individual Corporate DirectorBoard Member Jan 1, 2020
Kimberly Pladson Individual Corporate DirectorBoard Member Jan 1, 2025
Essentia Health Organization, Duluth, MN Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2023 100%
James M Christensen Individual Corporate DirectorBoard Member Jan 1, 2020
Corporate DirectorBoard Member Jun 1, 2021
Kevin S Boren Individual Corporate OfficerTreasurer Sep 29, 2025
Taylor Grant Mertz Individual Corporate DirectorBoard Member May 17, 2022
Anderson Saint Georges Individual Corporate DirectorBoard Member Jan 1, 2025
Michael Watters Individual Corporate Officer Jul 1, 2023
Corporate OfficerSecretary Jul 1, 2023
Alan J Hurley Individual Corporate OfficerCoo May 18, 2023
W-2 Managing Employee May 18, 2023
W-2 Managing EmployeeCoo May 18, 2023
Beverly Mary Horn Individual Corporate DirectorBoard Member Jan 1, 2017
Benjamin Cody Smith Individual Corporate DirectorBoard Member May 17, 2022
Douglas J Arvin Individual Corporate OfficerVP of Finance May 18, 2023
W-2 Managing EmployeeVP of Finance / Cfo May 18, 2023
Corporate OfficerVP of Finance/Cfo May 18, 2023
W-2 Managing EmployeeVP of Finance/Cfo May 18, 2023
Joel Ross Haugen Individual Corporate DirectorBoard Member Jan 1, 2017
Laurie Ann Lewandowski Individual Corporate DirectorBoard Member Jan 1, 2017
Corporate DirectorBoard Member Jan 1, 2011
Innovis Health LLC Organization, Fargo, ND Non-profit Operational/Managerial Control Jan 1, 2017
Operational/Managerial Control Apr 1, 2019
Marc Adams Individual Corporate DirectorBoard Member Jan 1, 2026
Mark Krejci Individual Corporate DirectorBoard Member Jan 1, 2026

Owners & managing parties with NPI records 11

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

Facilities with the same owner 50

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

View all 50

Practitioners & affiliated clinicians

Practitioners 264

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 264

Affiliated clinicians 352

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

View all 352

NPI Registry JSON

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

{
    "created_epoch": "1551657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709251200000",
    "number": "1902364482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 UNIVERSITY DR S",
            "address_2": "MEDICAL STAFF SERVICES-SSC",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581034940",
            "telephone_number": "701-364-8177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 E MAIN AVE",
            "city": "FRAZEE",
            "state": "MN",
            "postal_code": "565444504",
            "telephone_number": "218-334-7255",
            "fax_number": "218-334-4068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST MARY'S REGIONAL HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESSENTIA HEALTH",
        "enumeration_date": "2019-03-04",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A",
        "authorized_official_last_name": "HURLEY",
        "authorized_official_first_name": "ALAN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "701-364-7667"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health St. Mary's-Frazee Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Essentia Health St. Mary's-Frazee Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Frazee, MN

Sources for this page

Verify at the official NPI Registry.