NPIMap

Organization Active NPI

West River Health Services

Doing business as Mott Clinic

  • Rural Health Clinic/Center
  • Mott, ND
National Provider Identifier
1942398508
Registry record updated May 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WEST RIVER HEALTH SERVICES
Doing business as
Mott Clinic
Practice address
420 Pacific Ave
Mott, ND 58646
Phone
(701) 824-2391
Fax
(701) 824-2846
NPI assigned
Oct 10, 2006
Last updated
May 14, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2013

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

Authorized official

Name
Mr. James Long
Title
Ceo
Phone
(701) 567-6184

Specialties & licenses 1

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

Addresses

Primary practice location

420 Pacific Ave
Mott, ND 58646

Mailing address

1000 Highway 12
Hettinger, ND 58639-7530
Phone (701) 567-4561

Other identifiers 1

IdentifierTypeStateIssuer
005014MedicaidND

Other names 1

  • Mott Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040110000139 ND Part A Provider - Rural Health Clinic 0042127045 Practice locations: Mott, ND

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942398508. Details of each certification follow.

Rural health clinic certification: CCN 353980

Legal name
WEST RIVER HEALTH SERVICES
Doing business as
MOTT CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 1, 1991
Last certification
Oct 3, 2019
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Nov 30, 1998 in ND
Enrollment address
401 Millionaire Ave
Ste B
Mott, ND 58646-7270

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
West RVR Reg Med Hos10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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
Lynn Brown Individual Corporate Director Sep 19, 2018
Kurt Sargent Individual Corporate OfficerChief Financial Officer Nov 3, 2025
W-2 Managing EmployeeChief Financial Officer Nov 3, 2025
Troy Mosbrucker Individual Corporate DirectorRepresentative Sep 1, 2018
Alyson Freeland Individual Corporate OfficerCeo Oct 3, 2022
W-2 Managing EmployeeCeo Oct 3, 2022
Dave Erickson Individual Corporate Director Nov 2, 2020
Jonathon Eaton Individual Corporate DirectorBoard Member Sep 28, 2011
Brett Henderson Individual Corporate Director Nov 2, 2020

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368489600000",
    "number": "1942398508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 HIGHWAY 12",
            "city": "HETTINGER",
            "state": "ND",
            "postal_code": "586397530",
            "telephone_number": "701-567-4561",
            "fax_number": "701-567-6369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 PACIFIC AVE",
            "city": "MOTT",
            "state": "ND",
            "postal_code": "58646",
            "telephone_number": "701-824-2391",
            "fax_number": "701-824-2846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST RIVER HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2013-05-14",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "701-567-6184",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005014",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mott Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mott, ND

Sources for this page

Verify at the official NPI Registry.