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Presentation Medical Center

Organization Active NPI Clinic/Center · Rolla, ND

NPI 1992014518 · NPPES record last updated Jun 28, 2013

Key facts

NPI
1992014518
Entity type
Organization (NPI type 2)
Primary specialty
Clinic/Center 261Q00000X
License
5045A (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
Organization subpart
Yes
Parent organization (as reported)
PRESENTATION MEDICAL CENTER

Authorized official

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

Owned or controlled facilities with NPI records 2

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

Other NPIs with the same Medicare PAC ID 2

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

Corporate family (same tax ID) 4

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

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

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in ND

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
Corporation · Non-profit
Incorporated
Dec 27, 1954 in ND
Enrollment address
213 2ND Ave NE
Rolla, ND 58367-7153
Related CCNs
351316

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 Officer
Cfo		 Jan 1, 2003
W-2 Managing Employee
Cfo		 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. Kateri
Rolla, ND · CCN 351316		 Hospital Operational/Managerial Control Jan 1, 1973
SMP Health - St. Kateri
Rolla, ND · CCN 35Z316		 Hospital Operational/Managerial Control Jul 1, 2021

Medicare enrollment records

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

National Provider Directory

Tax ID family
Presentation Medical C (5 organizations share this tax ID)
Part of
Presentation Medical C

Specialties & licenses

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

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

IdentifierTypeStateIssuer
5202MedicaidND

Other providers in Rolla, ND

All providers in Rolla, ND · Clinic/Center in North Dakota

Sources for this page

Verify at the official NPI Registry.