Active NPI
Welia Health
- Rural Health Clinic/Center
- Pine City, MN
National Provider Identifier
1992012207
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rural Health Clinic/Center
- 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
- Last updated
- Jul 20, 2021
- Organization subpart
- Yes
- Parent organization
- WELIA HEALTH
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Randy Ulseth
- Title
- Ceo
- Phone
- (320) 679-1212
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | MN | Primary |
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 1
- Welia Health Pine City
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 2
| 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 |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1992012207. Details of each certification follow.
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
- Incorporated
- Oct 13, 2020 in MN
- Enrollment address
- 1425 Main St N
Pine City, MN 55063-6026 - Related CCNs
- 241367
Related certifications (CCN) 2
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).
Other NPIs on the same Medicare enrollment 3
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Part of
- Welia Health
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
-
dba Kanabec-Pine Community Health
- Public Health or Welfare Agency
- Mora, MN
- NPI 1669424198
Member Of
Locations
1425 Main St N
Pine City, MN 55063
Phone (320) 322-5141
Ownership & related parties
All disclosed owners & managing parties 16
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| 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% |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
Change-of-ownership history 2
| Date | Event | Counterparty |
|---|---|---|
| Jul 1, 2021 | Change of Ownership | Welia Health Pine City |
| Jul 1, 2021 | Change of Ownership | Welia Health Pine City |
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Critical Access Hospital
- Mora, MN
- NPI 1528031390
Practitioners & affiliated clinicians
Practitioners 162
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.
-
- Emergency Medicine Physician
- Duluth, MN
- NPI 1437509874
-
- Emergency Medicine Physician
- Zimmerman, MN
- NPI 1013030097
-
- Family Nurse Practitioner
- Staples, MN
- NPI 1962830026
-
- Hospitalist Physician
- Saint Cloud, MN
- NPI 1649269291
-
- Physician Assistant
- Sartell, MN
- NPI 1346733144
-
- Physician Assistant
- St Louis Park, MN
- NPI 1427023803
-
- Family Medicine Physician
- Mora, MN
- NPI 1437340437
-
- Family Medicine Physician
- Mora, MN
- NPI 1073995718
-
- Surgical Physician Assistant
- Plymouth, MN
- NPI 1003057118
-
- Family Nurse Practitioner
- Dawson, MN
- NPI 1326009630
-
- Family Medicine Physician
- Duluth, MN
- NPI 1033140660
-
- Family Medicine Physician
- Mora, MN
- NPI 1396705083
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283904000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1626739200000",
"number": "1992012207",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 HIGHWAY 65 S",
"city": "MORA",
"state": "MN",
"postal_code": "550511899",
"telephone_number": "320-679-1212",
"fax_number": "320-225-3345"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1425 MAIN STREET NORTH",
"city": "PINE CITY",
"state": "MN",
"postal_code": "550631530",
"telephone_number": "320-629-7505",
"fax_number": "320-629-2202"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WELIA HEALTH",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "WELIA HEALTH",
"enumeration_date": "2010-09-08",
"last_updated": "2021-07-20",
"certification_date": "2021-07-20",
"status": "A",
"authorized_official_last_name": "ULSETH",
"authorized_official_first_name": "RANDY",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "320-679-1212"
},
"taxonomies": [
{
"code": "261QR1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rural Health",
"state": "MN",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Welia Health Pine City",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Pine City, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.