NPIMap

Organization Active NPI

Altru Health System

Doing business as Altru Clinic - Greenbush

  • Rural Health Clinic/Center
  • Greenbush, MN
National Provider Identifier
1962591438
Registry record updated May 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ALTRU HEALTH SYSTEM
Doing business as
Altru Clinic - Greenbush
Practice address
19120 200TH St
Greenbush, MN 56726-9280
Phone
(218) 782-2400
NPI assigned
Oct 12, 2006
Last updated
May 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2024

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

Authorized official

Name
Derek Goebel
Title
Chief Financial Officer
Phone
(701) 780-1470

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

19120 200TH St
Greenbush, MN 56726-9280

Mailing address

PO Box 13780
Grand Forks, ND 58208-3780
Phone (701) 780-5000

Other names 1

  • Altru Clinic - Greenbush Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031110000135 MN Part B Supplier - Clinic/Group Practice 1355251604 Receives reassigned benefits from 217 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hallock, MN; Warroad, MN; Warren, MN; Thief River Falls, MN; Saint Paul, MN; Roseville, MN; Roseau, MN; Red Lake Falls, MN…

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Ownership & related parties

Change-of-ownership history 1

DateEventCounterparty
Jul 15, 2024 Change of OwnershipThis provider was the seller Lifecare Clinic GreenbushCCN 243496, MN, NPI 1558118919

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716422400000",
    "number": "1962591438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13780",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582083780",
            "telephone_number": "701-780-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19120 200TH ST",
            "city": "GREENBUSH",
            "state": "MN",
            "postal_code": "567269280",
            "telephone_number": "218-782-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTRU HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2024-05-23",
        "certification_date": "2024-05-23",
        "status": "A",
        "authorized_official_last_name": "GOEBEL",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "701-780-1470"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Altru Clinic - Greenbush",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Altru Clinic - Greenbush",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greenbush, MN

Sources for this page

Verify at the official NPI Registry.