NPIMap

Organization Active NPI

St Mary's Regional Health Center

Doing business as Essentia Health Hospice West

  • Community Based Hospice Care Agency
  • Fosston, MN
National Provider Identifier
1952484404
Registry record updated Mar 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
333820 Issued in MN
Legal business name
ST MARY'S REGIONAL HEALTH CENTER
Doing business as
Essentia Health Hospice West
Practice address
900 Hilligoss Blvd SE
Fosston, MN 56542-1542
Phone
(218) 435-7670
Fax
(218) 435-2175
NPI assigned
Oct 20, 2006
Last updated
Mar 1, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ESSENTIA HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 1, 2024

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

Authorized official

Name
Alan James Hurley
Title
Coo
Phone
(979) 820-4247

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 333820 MN Primary

Addresses

Primary practice location

900 Hilligoss Blvd SE
Fosston, MN 56542-1542

Mailing address

900 Hilligoss Blvd SE
Fosston, MN 56542-1542
Phone (218) 435-7670

Other names 1

  • Essentia Health Hospice West Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171115001791 MN Part A Provider - Hospice 2062326820 Practice locations: Fosston, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952484404. Details of each certification follow.

Hospice certification: CCN 241564

Legal name
ST MARYS REGIONAL HEALTH CENTER
Doing business as
ESSENTIA HEALTH HOSPICE WEST
Certification status
Active
Provider type (POS)
Hospice
Participating since
Mar 20, 1997
Last certification
Feb 28, 2019
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationNon-profit
Enrollment address
900 Hilligoss Blvd SE
Fosston, MN 56542-1542

Other NPIs with the same Medicare PAC ID 11

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Essentia Health Hospice WestCCN 241564 · All quality measures
Ownership
Non-Profit
Certified
Mar 20, 1997
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
St Marys Regional Healt11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Ownership & related parties

All disclosed owners & managing parties 18

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 OfficerPresident Aug 12, 2024
Tim D Heilman Individual Corporate DirectorBoard Member Jan 1, 2020
Marc Adams Individual Corporate DirectorBoard Member Jan 1, 2026
Mark Krejci Individual Corporate DirectorBoard Member Jan 1, 2026
Kimberly Pladson Individual Corporate DirectorBoard 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 DirectorBoard Member Jan 1, 2020
Kevin S Boren Individual Corporate OfficerTreasurer Sep 29, 2025
Taylor Grant Mertz Individual Corporate DirectorBoard Member May 17, 2022
Anderson Saint Georges Individual Corporate DirectorBoard Member Jan 1, 2025
Michael Watters Individual Corporate OfficerSecretary Jul 1, 2023
Alan J Hurley Individual Corporate OfficerCoo May 18, 2023
W-2 Managing Employee May 18, 2023
Amanda Christine Jackson-Morgan Individual W-2 Managing EmployeeMD; Sep 2, 2025
Benjamin Cody Smith Individual Corporate DirectorBoard Member May 17, 2022
Douglas J Arvin Individual Corporate OfficerVP of Finance May 18, 2023
W-2 Managing Employee May 18, 2023
Laurie Ann Lewandowski Individual Corporate DirectorBoard Member Jan 1, 2011
Kay Toczek Individual W-2 Managing EmployeeAd; May 6, 2024
Innovis Health LLC Organization, Fargo, ND Corporation, LLC Operational/Managerial Control Jan 1, 2011 100%

Owners & managing parties with NPI records 12

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

Facilities with the same owner 50

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

View all 50

Change-of-ownership history 2

DateEventCounterparty
Dec 1, 2017 Change of OwnershipThis provider was the buyer Essentia Health FosstonCCN 241564, MN, NPI 1952484404
Dec 1, 2017 Change of OwnershipThis provider was the seller Essentia Health Hospice WestCCN 241564, MN, NPI 1952484404

Practitioners & affiliated clinicians

Affiliated clinicians 2

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": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709251200000",
    "number": "1952484404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 HILLIGOSS BLVD SE",
            "city": "FOSSTON",
            "state": "MN",
            "postal_code": "565421542",
            "telephone_number": "218-435-7670",
            "fax_number": "218-435-2175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 HILLIGOSS BLVD SE",
            "city": "FOSSTON",
            "state": "MN",
            "postal_code": "565421542",
            "telephone_number": "218-435-7670",
            "fax_number": "218-435-2175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST MARY'S REGIONAL HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESSENTIA HEALTH",
        "enumeration_date": "2006-10-20",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A",
        "authorized_official_last_name": "HURLEY",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "979-820-4247"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MN",
            "license": "333820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Hospice West",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fosston, MN

Sources for this page

Verify at the official NPI Registry.