Welia Health
Organization Active NPI Rural Health Clinic/Center · Pine City, MN
NPI 1992012207 · NPPES record last updated Jul 20, 2021
Key facts
- NPI
- 1992012207
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- WELIA HEALTH
- Practice address
- 1425 Main Street North
Pine City, MN 55063-1530 - Phone
- (320) 629-7505
- Fax
- (320) 629-2202
- NPI assigned
- Sep 8, 2010
- Organization subpart
- Yes
- Parent organization (as reported)
- WELIA HEALTH
Authorized official
- Name
- Randy Ulseth
- Title
- Ceo
- Phone
- (320) 679-1212
Parent organization (reported in NPPES) 1
Owners & managing parties with NPI records 1
Other NPIs on the same Medicare enrollment 3
Other NPIs with the same Medicare PAC ID 5
Member of 1
Related certifications (CCN) 2
Practitioners 170
-
David Bidle, MD
-
Tanya Lynn Carlson, AGPCNP
-
Andrew M Clary, D.O.
-
Heidi Sue Deutschlander, RN, CNP
-
Ryan Jon Gaalswyk, M.D.
-
Matthew James Hamiel, CRNA
-
Erika Kay Herges, CNP
-
Jill Herges, NP-C
-
Chad Austin Holien, M.D.
-
Shih-an John Hsieh, M.D.
-
David William Kroll, CRNA
-
Reed R Larson, PA-C
-
Sandra J. Moore, NP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
Rural health clinic certification: CCN 243462
- Legal name
- WELIA HEALTH
- Doing business as
- WELIA HEALTH PINE CITY
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Mar 22, 2012
- Last certification
- Aug 28, 2019
- Ownership / control type
- Non-profit – church related
- Most recent change of ownership
- Jul 1, 2021 (1 total)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 13, 2020 in MN
- Enrollment address
- 1425 Main St N
Pine City, MN 55063-6026 - Related CCNs
- 241367
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Peter J Donner |
Corporate Director |
Jul 1, 2021 | 11.11% |
| Kim E Smith |
Corporate Director |
Jul 1, 2021 | 11.11% |
| Mary K Ellis |
Corporate Director |
Jul 1, 2021 | 11.11% |
| Diane Bankers |
W-2 Managing Employee |
Jul 1, 2021 | |
| Amy a Anderson |
Corporate Director |
Jul 1, 2021 | 11.11% |
| Julie J Schmidt |
Corporate Officer |
Jul 16, 2019 | 20% |
| Rebecca L Steffen |
Corporate Director |
Jul 1, 2021 | 11.11% |
| Sandra Zutz-Wiczek |
Corporate Officer |
Jan 12, 2015 | 20% |
| Theresa a Heggernes |
Corporate Director |
Jul 1, 2021 | 11.11% |
| Joshua R Asp |
Corporate Officer |
Sep 26, 2016 | 20% |
| Randy W Ulseth |
Corporate Officer |
Jan 1, 2002 | 20% |
| Sheila L Peterson |
W-2 Managing Employee |
Jul 1, 2021 | |
| Jack D Schwinghamer |
Corporate Director |
Jul 1, 2021 | 11.11% |
| Carl O Pederson |
Corporate Director |
Jul 1, 2011 | 11.11% |
| Ellen K Ryan |
Corporate Officer |
Aug 14, 1995 | 20% |
| Leslie B Nielsen |
Corporate Director |
Jul 1, 2021 | 11.11% |
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Jul 1, 2021 | Change of Ownership |
Welia Health Pine City |
| Jul 1, 2021 | Change of Ownership |
Welia Health Pine City |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210514001969 | MN | Part a Provider - Rural Health Clinic | 6709295496 | Practice locations: Pine City, MN |
| O20220125001227 | MN | Part B Supplier - Clinic/Group Practice | 6709295496 |
Receives reassigned benefits from 181 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Mora, MN; Pine City, MN; Hinckley, MN |
National Provider Directory
- Part of
- Welia Health
Locations
301 Highway 65 S
Mora, MN 55051
Phone (320) 225-3317
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | MN | Yes |
Addresses
Primary practice location
1425 Main Street North
Pine City, MN 55063-1530
Mailing address
301 Highway 65 S
Mora, MN 55051-1899
Phone (320) 679-1212
Other names
- Welia Health Pine City
Other providers in Pine City, MN
- Walker Eldercare Services Inc.
- Walmart Inc.
- Waxberg Clinic PA
- Jessica Juel Weidert
- Welia Health
- Kevin John Westerberg
- Billi J White
- Janice L Williams-Graff
- Crystal Lee Williams
- Alexandra Mary Smith Winship
All providers in Pine City, MN · Rural Health Clinic/Center in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2021. 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.