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Organization Active NPI

Stevens Community Medical Center Inc

Doing business as Stevens Community Medical Center Morris Clinic

  • Rural Health Clinic/Center
  • Morris, MN
National Provider Identifier
1942816624
Registry record updated Oct 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
STEVENS COMMUNITY MEDICAL CENTER INC
Doing business as
Stevens Community Medical Center Morris Clinic
Practice address
400 E 1St St
Morris, MN 56267-1408
Phone
(320) 589-1313
Fax
(320) 589-1065
NPI assigned
Sep 18, 2020
Last updated
Oct 6, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2022

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

Authorized official

Name
Kerrie McEvilly
Title
President/Ceo
Phone
(320) 589-1313

Specialties & licenses 1

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

Addresses

Primary practice location

400 E 1St St
Morris, MN 56267-1408

Mailing address

400 E 1St St
Morris, MN 56267-1408
Phone (320) 589-1313

Other names 1

  • Stevens Community Medical Center Morris Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201012000993 MN Part A Provider - Rural Health Clinic 3678475852 Practice locations: Morris, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942816624. Details of each certification follow.

Rural health clinic certification: CCN 243494

Legal name
STEVENS COMMUNITY MEDICAL CENTER INC
Doing business as
SCMC MORRIS CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 12, 2021
Last certification
Oct 12, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jun 6, 1984 in MN
Enrollment address
400 E 1St St
Morris, MN 56267-1408
Related CCNs
241363

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

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Stevens Comm Med Center3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Paul Martin Individual Corporate DirectorBoard Member Mar 1, 2008
Kerrie McEvilly Individual Corporate OfficerCoo Jun 1, 2020
Operational/Managerial ControlCoo Jan 1, 2021
Brent B Barnstuble Individual Operational/Managerial ControlMD Sep 1, 2024
Timothy Jay Individual Operational/Managerial ControlMD Mar 1, 2025
Bart Finzel Individual Corporate DirectorBoard Member Jan 1, 2007
Ward Voorhees Individual Corporate DirectorBoard Member Aug 1, 1996
Sarah Tahtinen Individual Corporate OfficerCfo Oct 16, 2025
Corporate DirectorCfo Oct 16, 2025
Operational/Managerial ControlCfo Oct 16, 2025
David Paul Individual Corporate DirectorBoard Member Jun 1, 2002
Toby Christie-Perkins Individual Corporate DirectorBoard Member Nov 1, 2016
Jodi Decamp Individual Corporate DirectorBoard Member Jan 1, 2005
Jan Hagen Individual Corporate DirectorBoard Member Jan 1, 2007
Rachel Johnson Individual Corporate DirectorBoard Member Jun 1, 2019

Owners & managing parties with NPI records 3

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

NPI Registry JSON

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

{
    "created_epoch": "1600387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665014400000",
    "number": "1942816624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E 1ST ST",
            "city": "MORRIS",
            "state": "MN",
            "postal_code": "562671408",
            "telephone_number": "320-589-1313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E 1ST ST",
            "city": "MORRIS",
            "state": "MN",
            "postal_code": "562671408",
            "telephone_number": "320-589-1313",
            "fax_number": "320-589-1065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEVENS COMMUNITY MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-18",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A",
        "authorized_official_last_name": "MCEVILLY",
        "authorized_official_first_name": "KERRIE",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "320-589-1313"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stevens Community Medical Center Morris Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Morris, MN

Sources for this page

Verify at the official NPI Registry.