NPIMap

Organization Active NPI

St Andrews Hospital

Doing business as St Andrew's Health Center

  • Critical Access Hospital
  • Bottineau, ND
National Provider Identifier
1912093725
Registry record updated Mar 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
ST ANDREWS HOSPITAL
Doing business as
St Andrew's Health Center
Practice address
316 Ohmer St
Bottineau, ND 58318-1045
Phone
(701) 228-9300
Fax
(701) 228-9384
NPI assigned
Oct 5, 2006
Last updated
Mar 28, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
1912093725As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 28, 2011

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

Authorized official

Name
Ms. Jodi L Atkinson
Title
Ceo/President
Phone
(701) 228-9300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X Primary

Addresses

Primary practice location

316 Ohmer St
Bottineau, ND 58318-1045

Mailing address

316 Ohmer St
Bottineau, ND 58318-1045
Phone (701) 228-9300

Other identifiers 1

IdentifierTypeStateIssuer
1904MedicaidND

Other names 1

  • St Andrew's Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110328000496 ND Part A Provider - Critical Access Hospital 4880505999 Receives reassigned benefits from 1 practitioner
Practice locations: Bottineau, ND

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912093725. Details of each certification follow.

Hospital certification: CCN 35Z307

Legal name
ST ANDREWS HOSPITAL
Doing business as
SMP HEALTH - ST ANDREWS
Organization structure
CorporationNon-profit
Incorporated
Mar 29, 1945 in ND
Enrollment address
316 Ohmer St
Bottineau, ND 58318-1045
Hospital Swing-Bed Unit

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

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
St Andrews Hospital5 organizations share this tax ID, including this one
Part of
St Andrews Hospital

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Brenda Arneson Individual W-2 Managing Employee Jan 1, 2019 100%
Melissa Block Individual Corporate Director Jul 1, 2015 100%
Collin Serhienko Individual Corporate DirectorDirector Jul 1, 2023 100%
Rick Gustafson Individual Corporate Director Jul 1, 2021 100%
Jeremi Tweed Individual Corporate Director Jul 1, 2017 100%
Christopher Albertson Individual Corporate OfficerCeo/President Oct 1, 2020 100%
Operational/Managerial ControlCeo/President Oct 1, 2020 100%
Courtney Vandal Individual Corporate OfficerCfo Aug 1, 2020

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
SMP Health - St. Andrew'sBottineau, ND, CCN 358508 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 30, 2020

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301270400000",
    "number": "1912093725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 OHMER ST",
            "city": "BOTTINEAU",
            "state": "ND",
            "postal_code": "583181045",
            "telephone_number": "701-228-9300",
            "fax_number": "701-228-9384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 OHMER ST",
            "city": "BOTTINEAU",
            "state": "ND",
            "postal_code": "583181045",
            "telephone_number": "701-228-9300",
            "fax_number": "701-228-9384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST ANDREWS HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "1912093725",
        "enumeration_date": "2006-10-05",
        "last_updated": "2011-03-28",
        "status": "A",
        "authorized_official_last_name": "ATKINSON",
        "authorized_official_first_name": "JODI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "701-228-9300",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1904",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Andrew's Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bottineau, ND

Sources for this page

Verify at the official NPI Registry.