ESSENTIA HEALTH MOOSE LAKE (NPI# 1932738218) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932738218 |
| Entity Type | Organization |
| Organization Name | ESSENTIA HEALTH MOOSE LAKE |
| Practice Address |
4572 County Road 61 Moose Lake MN 55767-9401 |
| Practice Telephone | 2184854481 |
| Mailing Telephone | 2184854481 |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2020-04-07 |
| Authorized Official Name | BRADLEY BEARD (CHIEF OPERATING OFFICER) |
| Authorized Official Telephone | 2187862652 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 275N00000X | Medicare Defined Swing Bed Unit | Hospital Units |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437778529 | Essentia Health Moose Lake | Home Health | 30 Arrowhead Ln, Moose Lake, MN 55767 | 2020-04-09 |
| 1154959880 | Essentia Health Moose Lake | General Acute Care Hospital | 4572 County Road 61, Moose Lake, MN 55767-9401 | 2020-03-30 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | ESSENTIA HEALTH MOOSE LAKE | 4572 County Road 61, Moose Lake, MN 55767-9401 |
| Street Address |
4572 COUNTY ROAD 61 |
| City | MOOSE LAKE |
| State | MN |
| Zip Code | 55767-9401 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508809930 | Mark Conrad Gregerson | Orthopaedic Surgery | 4572 County Road 61, Moose Lake, MN 55767-9401 | 2006-06-14 |
| 1609494657 | Nicholas T Allard | Physical Therapist | 4572 County Road 61, Moose Lake, MN 55767-9401 | 2020-07-07 |
| 1295353258 | Jennifer S Gangelhoff | Occupational Therapist | 4572 County Road 61, Moose Lake, MN 55767-9401 | 2020-07-07 |
| 1164040176 | Ashley I Omar | Occupational Therapist | 4572 County Road 61, Moose Lake, MN 55767-9401 | 2020-07-07 |
| 1134747140 | Claire L Rosen | Occupational Therapist | 4572 County Road 61, Moose Lake, MN 55767-9401 | 2020-07-07 |
| 1750909735 | Keri A Halverson | Speech-Language Pathologist | 4572 County Road 61, Moose Lake, MN 55767-9401 | 2020-07-07 |
| 1629696620 | Magdalena K Hoelmer | Physical Therapist | 4572 County Road 61, Moose Lake, MN 55767-9401 | 2020-07-07 |
| 1154959880 | Essentia Health Moose Lake | General Acute Care Hospital | 4572 County Road 61, Moose Lake, MN 55767-9401 | 2020-03-30 |
| 1245758234 | James Alan Mach Jr. | Nurse Anesthetist, Certified Registered | 4572 County Road 61, Moose Lake, MN 55767-9401 | 2017-08-30 |
| 1023551108 | Samantha Goude | Physical Therapist | 4572 County Road 61, Moose Lake, MN 55767-9401 | 2016-11-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437778529 | Essentia Health Moose Lake | Home Health | 30 Arrowhead Ln, Moose Lake, MN 55767 | 2020-04-09 |
| 1841775475 | Katherine Mcdowell | Social Worker | 451 Arrowhead Lane, Moose Lake, MN 55767 | 2018-09-28 |
| 1316191786 | Vision Pro | Optometrist | 125 W Arrowhead Rd, Moose Lake, MN 55767 | 2008-11-11 |
| 1265627327 | Dr. Joseph J. Jamros Optometry, Ltd. | Optometrist | 312 Elm Ave., Moose Lake, MN 55767 | 2007-09-12 |
| 1013108075 | Diane Louise Stellrecht | Psychologist | 505 3rd Street, Suite A, Moose Lake, MN 55767 | 2007-08-06 |
| 1073674529 | Downtown Dental Care Pa | Dentist | 304 Elm Ave, Moose Lake, MN 55767 | 2006-12-12 |
| 1760558399 | Joseph John Jamros | Optometrist | 312 Elm Ave, Moose Lake, MN 55767 | 2006-11-27 |
| 1205909991 | Msocs-moose Lake | Intermediate Care Facility, Mentally Retarded | 305 4th St, Moose Lake, MN 55767 | 2006-11-17 |
| 1295804482 | Moose Lake Community Hospital District | Home Health | 30 Arrowhead Lane, Moose Lake, MN 55767 | 2006-11-06 |
| 1396770772 | Sonja M. Roach | Nurse Practitioner | 4570 County Highway 61, Moose Lake, MN 55767 | 2006-07-12 |
| Find all providers in zip 55767 | ||||
| Taxonomy Code | 275N00000X |
| Grouping | Hospital Units |
| Classification | Medicare Defined Swing Bed Unit |
| A unit of a hospital that has a Medicare provider agreement and has been granted approval from HCFA to provide post-hospital extended care services and be reimbursed as a swing-bed unit. |
| Notes: Source: Code of Federal Regulations #42, Section 482.66. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881039659 | Metropolitan Health Medical Center | Medicare Defined Swing Bed Unit | 3055 Old Highway 8 Ste 2, St Anthony, MN 55418-2500 | 2013-05-07 |
| 1952359614 | Centracare Health System - Long Prairie | Medicare Defined Swing Bed Unit | 50 Centracare Dr, Long Prairie, MN 56347 | 2006-05-05 |
| 1952370348 | City of Sleepy Eye | Medicare Defined Swing Bed Unit | 400 4th Ave Nw, Sleepy Eye, MN 56085-1109 | 2006-03-16 |
| 1578106498 | Avera Granite Falls | Medicare Defined Swing Bed Unit | 345 10th Ave, Granite Falls, MN 56241-1442 | 2019-10-23 |
| 1285116061 | Carris Health - Redwood LLC | Medicare Defined Swing Bed Unit | 100 Fallwood Rd, Redwood Falls, MN 56283-1828 | 2018-08-29 |
| 1578078036 | Winona Health Services | Medicare Defined Swing Bed Unit | 855 Mankato Ave, Winona, MN 55987-4868 | 2017-12-06 |
| 1649705690 | Stevens Community Medical Center Inc | Medicare Defined Swing Bed Unit | 400 E. 1st Street, Morris, MN 56267 | 2017-04-27 |
| 1316374978 | Bridges Medical Center | Medicare Defined Swing Bed Unit | 201 9th St W, Ada, MN 56510-1279 | 2013-09-27 |
| 1457786972 | Centracare Health-paynesville LLC | Medicare Defined Swing Bed Unit | 200 W 1st St, Paynesville, MN 56362-1445 | 2013-09-04 |
| 1902243280 | Northern Pines Medical Center | Medicare Defined Swing Bed Unit | 5211 Highway 110, Aurora, MN 55705-1522 | 2013-05-28 |
| Find all providers with the same taxonomy | ||||
| City | MOOSE LAKE |
| Zip Code | 55767 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.