Northern Pines Medical Center

Primary specialty

Institutional PharmacyTaxonomy code 3336I0012X

License

200749 Issued in MN

Legal business name

NORTHERN PINES MEDICAL CENTER

Doing business as

Essentia Health Northern Pines Medical

Practice address

5211 Highway 110
Aurora, MN 55705-1522

Phone

(218) 229-4210

Fax

(218) 229-4261

NPI assigned

Sep 28, 2011

Last updated

Apr 26, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

James Tomsche, RPH

Title

Director of Acute Care Pharmac

Phone

(218) 786-4346

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• ESSENTIA HEALTH NORTHERN PINES MEDICAL Doing business as

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

{
    "created_epoch": "1317168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461628800000",
    "number": "1053694885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5211 HIGHWAY 110",
            "city": "AURORA",
            "state": "MN",
            "postal_code": "557051522",
            "telephone_number": "218-229-4210",
            "fax_number": "218-229-4261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5211 HIGHWAY 110",
            "city": "AURORA",
            "state": "MN",
            "postal_code": "557051522",
            "telephone_number": "218-229-4210",
            "fax_number": "218-229-4261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN PINES MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-28",
        "last_updated": "2016-04-26",
        "status": "A",
        "authorized_official_last_name": "TOMSCHE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "DIRECTOR OF ACUTE CARE PHARMAC",
        "authorized_official_telephone_number": "218-786-4346",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "MN",
            "license": "200749",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2045668",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "173347800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ESSENTIA HEALTH NORTHERN PINES MEDICAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mikaela Celine Lake, DO
• Ericka Janette Lamar, PSYD, LP
• Mesabacare LLC
• Catherine Marie Mitchell, DO
• Christopher Mitchell
• Northern Pines Medical Center (Essentia Health Northern Pines Care Center)
• Northern Pines Medical Center (Essentia Health Northern Pines Clinic)
• Northern Pines Medical Center (Essentia Health Northern Pines)
• Northern Pines Medical Center
• Northern Pines Medical Center (Essentia Health Northern Pines Clinic)

• Institutional Pharmacy in Aurora, MN
• Providers in Aurora, MN by specialty
• Institutional Pharmacy in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.