Cook Area Health Services, Inc
Organization Active NPI Clinic/Center · Northome, MN
NPI 1912970849 · NPPES record last updated Aug 7, 2025
Key facts
- NPI
- 1912970849
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- COOK AREA HEALTH SERVICES, INC
- Practice address
- 12052 Main St
Northome, MN 56661-0066 - Phone
- (218) 897-5222
- Fax
- (218) 897-5226
- NPI assigned
- Feb 10, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Keith D Harvey
- Title
- Ceo
- Phone
- (218) 666-5941
Owners & managing parties with NPI records 1
-
Jeffrey P Scrivner, M.D.
Other NPIs on the same Medicare enrollment 6
Other NPIs with the same Medicare PAC ID 6
Practitioners 28
-
Kristen Dombovy, DNP
-
Emily Marie Hadrava, RN, CNP
-
Julie Anne Miller, FNP
-
Barret J Myers, M.D.
-
Cynthia A Sandberg, CFNP CPNP RN
-
Heidi Jean Schminski, APRN, CNP
-
Eric P Scrivner, M.D.
-
Jeffrey P Scrivner, M.D.
-
Nicholas Brian Vidor, M.D.
-
Allison L Weddle, APRN
-
Kari Ann Drake, PA-C
-
Matthew Anders Holmes, M.D.
-
Katherine Joy Leppert, APRN, NP
-
Erin R Thielbar, FNP-C
-
Kiara Westendorf, LICSW
-
Emily Kate Wild, CNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in MN
Federally qualified health center certification: CCN 241812
- Legal name
- COOK AREA HEALTH SERVICES, INC
- Doing business as
- SCENIC RIVERS HEALTH SERVICES
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 1, 1979 in MN
- Enrollment address
- 12052 Main St
Northome, MN 56661-8074
Federally qualified health center certification: CCN 241811
- Legal name
- COOK AREA HEALTH SERVICES, INC
- Doing business as
- SCENIC RIVERS HEALTH SERVICES
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 1, 1991
- Last certification
- Oct 1, 1991
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 1, 1979 in MN
- Enrollment address
- 410 2ND St NW
Big Falls, MN 56627-0218
All disclosed owners & managing parties 18
| Name | Role | Since | Share |
|---|---|---|---|
| Stephanie a Burckhardt |
Corporate Director |
Jan 1, 2015 | |
| Wende Nelson |
Corporate Director |
Jan 1, 2016 | |
| Daniel Kerr |
Corporate Director |
Jan 1, 2019 | |
| Robert Walker |
Corporate Director |
Jan 1, 2019 | |
| Corporate Director | Jan 1, 2021 | ||
| Mary G Blackmer |
Corporate Officer |
Jan 1, 1992 | |
| Corporate Director |
Jan 1, 1992 | ||
| Karen M Lorenzen |
Corporate Director |
Jan 1, 2013 | |
| William N Swanberg |
Corporate Director |
Jul 1, 2018 | |
| Richard V Hanson |
Corporate Director |
Apr 1, 2017 | |
| Corporate Director | Apr 1, 2017 | ||
| W-2 Managing Employee |
May 1, 1979 | ||
| Marian a Swang |
Corporate Director |
Jan 1, 2013 | |
| Michael a Holmes |
Corporate Officer | May 1, 1979 | |
| W-2 Managing Employee |
May 1, 1979 | ||
| Operational/Managerial Control |
May 1, 1979 | ||
| Corporate Officer |
Jun 23, 2010 | ||
| Jeffrey P Scrivner |
W-2 Managing Employee |
Nov 1, 1987 | |
| Operational/Managerial Control |
Nov 1, 1984 | ||
| Diane J Gallagher |
Corporate Director | Apr 1, 2017 | |
| William H Tibbetts |
Corporate Officer |
Jan 1, 2002 | |
| Corporate Director |
Jan 1, 2002 | ||
| Keith D Harvey |
Corporate Officer |
Jul 21, 2014 | |
| W-2 Managing Employee |
Jul 21, 2014 | ||
| Operational/Managerial Control |
Jul 21, 2014 | ||
| Corporate Officer |
Jul 21, 2014 | ||
| Dianne L Bakke |
Corporate Director |
Jan 1, 2015 | |
| Elizabeth G Storm |
Corporate Director |
Jan 1, 2022 | |
| Marci L Maple |
Corporate Director |
Jan 1, 2021 | |
| Robin Harkonen |
Corporate Director |
Jan 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040427001470 | MN | Part B Supplier - Clinic/Group Practice | 4880681303 |
Receives reassigned benefits from 35 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Eveleth, MN; Tower, MN; Northome, MN; Floodwood, MN; Cook, MN; Bigfork, MN; Big Falls, MN |
| O20040707000142 | MN | Part a Provider - Federally Qualified Health Center (FQHC) | 4880681303 | Practice locations: Northome, MN |
| O20101119001059 | MN | Part a Provider - Federally Qualified Health Center (FQHC) | 4880681303 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Big Falls, MN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Yes |
Addresses
Primary practice location
12052 Main St
Northome, MN 56661-0066
Mailing address
PO Box 66
12052 Main St
Northome, MN 56661-0066
Phone (218) 897-5222
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 241812 | Other | MEDICARE | |
| 1912970849 | Medicaid | MN | |
| 216354300 | Medicaid | MN |
Other names
- Scenic Rivers Health Services
Other providers in Northome, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 7, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.