Mayo Clinic Health System - Fairmont
800 Medical Center Drive, Po Box 800, Fairmont, MN 56031


Mayo Clinic Health System - Fairmont is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 245274. The address is 800 Medical Center Drive, Po Box 800, Fairmont, MN 56031. The zip code is 56031. The phone number is 5072388651.


Mayo Clinic Health System - Fairmont · 800 Medical Center Drive, Po Box 800, Fairmont, MN 56031

Federal Provider Number 245274
Provider Name MAYO CLINIC HEALTH SYSTEM - FAIRMONT
Address 800 MEDICAL CENTER DRIVE, PO BOX 800
FAIRMONT, MN 56031
Phone Number 5072388651
SSA County Code 450
County Name Martin
Ownership Type Non profit - Corporation
Certified Beds 40
Certified Beds Residents 24
Provider Type Medicare and Medicaid
Resides in Hospital true
Legal Business Name MAYO CLINIC HEALTH SYSTEM FAIRMONT
Date First Approved to Provide Medicare Medicaid Services 04/01/1985
Continuing Care Retirement Community false
Special Focus Facility false
Most Recent Health Inspection More Than 2 Years Ago false
Changed Ownership Last 12 Months false
With Resident Family Council Both
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 2
Health Inspection Rating 1
Quality Measure Rating 3
Staffing Rating 5
RN Staffing Rating 5
Reported CNA Staffing Hours per Resident per Day 3.68125
Reported LPN Staffing Hours per Resident per Day 0.86875
Reported RN Staffing Hours per Resident per Day 1.43542
Reported Licensed Staffing Hours per Resident per Day 2.30417
Reported Total Nurse Staffing Hours per Resident per Day 5.98542
Expected CNA Staffing Hours per Resident per Day 2.56203
Expected LPN Staffing Hours per Resident per Day 0.6097
Expected RN Staffing Hours per Resident per Day 0.99903
Expected Total Nurse Staffing Hours per Resident per Day 4.17076
Adjusted CNA Staffing Hours per Resident per Day 3.52559
Adjusted LPN Staffing Hours per Resident per Day 1.18266
Adjusted RN Staffing Hours per Resident per Day 1.07358
Adjusted Total Nurse Staffing Hours per Resident per Day 5.7847
Cycle 1 Total Number of Health Deficiencies 11
Cycle 1 Number of Standard Health Deficiencies 10
Cycle 1 Number of Complaint Health Deficiencies 1
Cycle 1 Health Deficiency Score 72
Cycle 1 Standard Survey Health Date 11/09/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 72
Cycle 2 Total Number of Health Deficiencies 9
Cycle 2 Number of Standard Health Deficiencies 9
Cycle 2 Health Deficiency Score 36
Cycle 2 Standard Health Survey Date 10/29/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 36
Cycle 3 Total Number of Health Deficiencies 8
Cycle 3 Number of Standard Health Deficiencies 8
Cycle 3 Health Deficiency Score 48
Cycle 3 Standard Health Survey Date 12/19/2014
Cycle 3 Number of Health Revisits 2
Cycle 3 Health Revisit Score 24
Cycle 3 Total Health Score 72
Total Weighted Health Survey Score 60
Number of Facility Reported Incidents 2
Number of Fines 1
Total Amount of Fines in Dollars $4388.00
Total Number of Penalties 1
Processing Date 08/01/2017

Owner or Manager · Mayo Clinic Health System - Fairmont

Owner Name Role Association Date
BRANDT, TERRY (Individual) OFFICER since 01/01/2017
BRANDT, TERRY (Individual) OPERATIONAL/MANAGERIAL CONTROL since 01/01/2017
BROLSMA, GREG (Individual) DIRECTOR since 01/01/2007
CORCHRAN, MICHALE (Individual) MANAGING EMPLOYEE since 01/01/2016
GAALSWYK, MARK (Individual) DIRECTOR since 08/25/2008
GREEN, JEFFREY (Individual) DIRECTOR since 01/01/2010
GREEN, JEFFREY (Individual) OFFICER since 08/22/2011
HEBL, JAMES (Individual) OFFICER since 07/01/2016
KOCH, MARK (Individual) OFFICER since 07/25/2012
LARDY, TRACI (Individual) DIRECTOR since 06/01/2013
MAYO CLINIC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 01/01/2015
MAYO CLINIC HEALTH SYSTEM-MANKATO (Organization) OPERATIONAL/MANAGERIAL CONTROL since 05/23/2011
MORRIS, MARIE (Individual) DIRECTOR since 12/10/2010
MORRIS, MARIE (Individual) OFFICER since 12/10/2010
STRUCK, ALLEN (Individual) DIRECTOR since 01/01/2005
STRUCK, ALLEN (Individual) OFFICER since 01/01/2005
TARASOVITCH, JAMES (Individual) MANAGING EMPLOYEE since 11/01/2011
TARASOVITCH, JAMES (Individual) OFFICER since 11/01/2011

street_number: 800
route: Center Creek Drive
locality, political: Fairmont
admin_level_2, political: Martin County
admin_level_1, political: Minnesota (MN)
country, political: United States (US)
postal_code: 56031
postal_code_suffix: 4575
types : doctor, establishment, health, point_of_interest
latitude: 43.6713841
longitude: -94.4458967
latlng: (43.6713841, -94.4458967)


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