NPIMap

Organization Active NPI

St Joseph's Medical Center

Doing business as Essentia Health St Joseph's Deerwood Clinic

  • Multi-Specialty Clinic/Center
  • Deerwood, MN
National Provider Identifier
1033814066
Registry record updated Feb 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
ST JOSEPH'S MEDICAL CENTER
Doing business as
Essentia Health St Joseph's Deerwood Clinic
Practice address
24087 Cuyuna St
Deerwood, MN 56444-3301
Phone
(218) 833-5160
Fax
(218) 833-5169
NPI assigned
Mar 31, 2023
Last updated
Feb 27, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ESSENTIA HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 27, 2024

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

Authorized official

Name
Kevin Boren
Title
VP of Finance
Phone
(218) 786-1009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

24087 Cuyuna St
Deerwood, MN 56444-3301

Mailing address

24087 Cuyuna St
Deerwood, MN 56444-3301
Phone (218) 833-5160

Other names 1

  • Essentia Health St Joseph's Deerwood Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031119000468 MN Part B Supplier - Clinic/Group Practice 8224948443 Receives reassigned benefits from 361 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pequot Lakes, MN; Pierz, MN; Pillager, MN; Pine River, MN; Plymouth, MN; Saint Paul, MN; Crosslake, MN; Shoreview, MN…

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

National Provider Directory

National Provider Directory
Tax ID family
St Joseph's Medical CNT12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1680220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708992000000",
    "number": "1033814066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24087 CUYUNA ST",
            "city": "DEERWOOD",
            "state": "MN",
            "postal_code": "564443301",
            "telephone_number": "218-833-5160",
            "fax_number": "218-833-5169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24087 CUYUNA ST",
            "city": "DEERWOOD",
            "state": "MN",
            "postal_code": "564443301",
            "telephone_number": "218-833-5160",
            "fax_number": "218-833-5169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOSEPH'S MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESSENTIA HEALTH",
        "enumeration_date": "2023-03-31",
        "last_updated": "2024-02-27",
        "certification_date": "2024-02-27",
        "status": "A",
        "authorized_official_last_name": "BOREN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "218-786-1009"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health St Joseph's Deerwood Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Essentia Health St Joseph's Deerwood Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Deerwood, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.