NPIMap

Organization Active NPI

Presentation Medical Center

  • Clinic/Center
  • Rolla, ND
National Provider Identifier
1992014518
Registry record updated Jun 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
5045A Issued in ND
Legal business name
PRESENTATION MEDICAL CENTER
Practice address
213 2ND Ave NE
Rolla, ND 58367-7153
Phone
(701) 477-3161
Fax
(701) 477-5564
NPI assigned
Sep 30, 2010
Last updated
Jun 28, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
PRESENTATION MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 28, 2013

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

Authorized official

Name
Ms. Paula J Wilkie
Title
Cfo
Phone
(701) 477-1951

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 5045A ND Primary

Addresses

Primary practice location

213 2ND Ave NE
Rolla, ND 58367-7153

Mailing address

213 2ND Ave NE
Rolla, ND 58367-7153
Phone (701) 477-3161

Other identifiers 1

IdentifierTypeStateIssuer
5202MedicaidND

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120627000373 ND Part A Provider - Rural Health Clinic 5991764045 Practice locations: Rolla, ND

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992014518. Details of each certification follow.

Rural health clinic certification: CCN 358506

Legal name
PRESENTATION MEDICAL CENTER
Doing business as
SMP HEALTH - ST. KATERI
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 10, 2012
Last certification
Oct 15, 2019
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Dec 27, 1954 in ND
Enrollment address
213 2ND Ave NE
Rolla, ND 58367-7153
Related CCNs
351316

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

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Presentation Medical C5 organizations share this tax ID, including this one
Part of
Presentation Medical C

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Jane Sivertson Individual Corporate Director Jul 1, 2012
Lori Martinson Individual W-2 Managing Employee Nov 5, 2013
Matthew Odermann Individual Corporate Director Jul 1, 2018
Shelley Counts Individual Corporate Director Jul 1, 2020
Paula Wilkie Individual Corporate OfficerCfo Jan 1, 2003
W-2 Managing EmployeeCfo Feb 1, 2012
Debra Berry Individual Corporate Director Jul 1, 2021
Christopher Albertson Individual Corporate Officer Oct 1, 2017
Steven McAtee Individual Corporate Director Jul 1, 2017

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
SMP Health - St. KateriRolla, ND, CCN 351316 Hospital Operational/Managerial Control Jan 1, 1973
SMP Health - St. KateriRolla, ND, CCN 35Z316 Hospital Operational/Managerial Control Jul 1, 2021

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1285804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372377600000",
    "number": "1992014518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 2ND AVE NE",
            "city": "ROLLA",
            "state": "ND",
            "postal_code": "583677153",
            "telephone_number": "701-477-3161",
            "fax_number": "701-477-5564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 2ND AVE NE",
            "city": "ROLLA",
            "state": "ND",
            "postal_code": "583677153",
            "telephone_number": "701-477-3161",
            "fax_number": "701-477-5564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESENTATION MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRESENTATION MEDICAL CENTER",
        "enumeration_date": "2010-09-30",
        "last_updated": "2013-06-28",
        "status": "A",
        "authorized_official_last_name": "WILKIE",
        "authorized_official_first_name": "PAULA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "701-477-1951",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "ND",
            "license": "5045A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5202",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rolla, ND

Sources for this page

Verify at the official NPI Registry.