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St Mary'S Regional Health Center

Organization Active NPI Rural Health Clinic/Center · Frazee, MN

NPI 1902364482 · NPPES record last updated Mar 1, 2024

Key facts

NPI
1902364482
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
ST MARY'S REGIONAL HEALTH CENTER
Practice address
300 E Main Ave
Frazee, MN 56544-4504
Phone
(218) 334-7255
Fax
(218) 334-4068
NPI assigned
Mar 4, 2019
Organization subpart
Yes
Parent organization (as reported)
ESSENTIA HEALTH

Authorized official

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

Owners & managing parties with NPI records 11

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

Other NPIs on the same Medicare enrollment 13

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

Other NPIs with the same Medicare PAC ID 11

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

Corporate family (same tax ID) 10

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

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

Facilities with the same owner 50

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

View all 50

Practitioners 293

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 293

Affiliated clinicians 352

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

View all 352

Medicare Care Compare: Hospital

Listed as
Essentia Health St Marys - Detroit Lakes CCN 240101
Overall star rating
★★★★☆ 4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Church
Medicare certification status
Active (Provider of Services file)
Emergency services
No

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (3 enrollments) in MN

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
Corporation · Non-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
Corporation · Non-profit
Enrollment address
300 E Main Ave
Frazee, MN 56544-4504
Related CCNs
240101

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 Officer
President		 Aug 12, 2024
Tim D Heilman
Individual 		Corporate Director
Board Member		 Jan 1, 2020
Corporate Director
Board Member		 Jun 16, 2021
Aarick L Jackson
Individual 		Corporate Director
Board Member		 Jan 1, 2020
Kimberly Pladson
Individual 		Corporate Director
Board 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 Director
Board Member		 Jan 1, 2020
Corporate Director
Board Member		 Jun 1, 2021
Kevin S Boren
Individual 		Corporate Officer
Treasurer		 Sep 29, 2025
Taylor Grant Mertz
Individual 		Corporate Director
Board Member		 May 17, 2022
Anderson Saint Georges
Individual 		Corporate Director
Board Member		 Jan 1, 2025
Michael Watters
Individual 		Corporate Officer Jul 1, 2023
Corporate Officer
Secretary		 Jul 1, 2023
Alan J Hurley
Individual 		Corporate Officer
Coo		 May 18, 2023
W-2 Managing Employee May 18, 2023
W-2 Managing Employee
Coo		 May 18, 2023
Beverly Mary Horn
Individual 		Corporate Director
Board Member		 Jan 1, 2017
Benjamin Cody Smith
Individual 		Corporate Director
Board Member		 May 17, 2022
Douglas J Arvin
Individual 		Corporate Officer
VP of Finance		 May 18, 2023
W-2 Managing Employee
VP of Finance / Cfo		 May 18, 2023
Corporate Officer
VP of Finance/Cfo		 May 18, 2023
W-2 Managing Employee
VP of Finance/Cfo		 May 18, 2023
Joel Ross Haugen
Individual 		Corporate Director
Board Member		 Jan 1, 2017
Laurie Ann Lewandowski
Individual 		Corporate Director
Board Member		 Jan 1, 2017
Corporate Director
Board 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 Director
Board Member		 Jan 1, 2026
Mark Krejci
Individual 		Corporate Director
Board Member		 Jan 1, 2026

Medicare enrollment records

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

National Provider Directory

Tax ID family
St Marys Regional HLTH (11 organizations share this tax ID)

Locations

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

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

1415 Madison Ave
Detroit Lakes, MN 56501
Phone (218) 844-7119

Specialties & licenses

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

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

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 1, 2024.

{
    "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

All providers in Frazee, MN · Rural Health Clinic/Center in Minnesota

Sources for this page

Verify at the official NPI Registry.