NPIMap

Organization Active NPI

Northern Pines Medical Center

Doing business as Essentia Health Northern Pines Care Center

  • Skilled Nursing Facility
  • Aurora, MN
National Provider Identifier
1063511020
Registry record updated Feb 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
NORTHERN PINES MEDICAL CENTER
Doing business as
Essentia Health Northern Pines Care Center
Practice address
5211 Highway 110
Aurora, MN 55705-1522
Phone
(218) 229-2211
Fax
(218) 229-2042
NPI assigned
Sep 22, 2006
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
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

5211 Highway 110
Aurora, MN 55705-1522

Mailing address

5211 Highway 110
Aurora, MN 55705-1522
Phone (218) 229-2211

Other identifiers 1

IdentifierTypeStateIssuer
1063511020MedicaidMN

Other names 1

  • Essentia Health Northern Pines Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090603000100 MN Part A Provider - Skilled Nursing Facility 3870565641 Practice locations: Aurora, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063511020. Details of each certification follow.

Skilled nursing facility certification: CCN 245469

Legal name
NORTHERN PINES MEDICAL CENTER
Doing business as
ESSENTIA HEALTH NORTHERN PINES CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 1, 1987
Last certification
Jan 30, 2025
Beds
33
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Essentia Health
Organization structure
CorporationNon-profit
Enrollment address
5211 Highway 110
Aurora, MN 55705-1522
Nursing home name
ESSENTIA HEALTH NORTHERN PINES MEDICAL CENTER
Affiliated entity
ESSENTIA HEALTH

Other NPIs with the same Medicare PAC ID 3

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Essentia Health Northern Pines Medical CenterCCN 245469 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
5 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Apr 1, 1987
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
3331.4 residents per day on average
Chain
Essentia Health6 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Northern Pines Medical Ctr4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

5211 Highway 110
Aurora, MN 55705
Phone (218) 229-1010

Ownership & related parties

All disclosed owners & managing parties 18

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Krista Ann Skorupa Individual Corporate OfficerPresident May 6, 2024
Amy Bergstrom Individual Corporate DirectorBoard Member Jan 1, 2024
Anthony Sertich Individual Corporate DirectorBoard Member Jan 1, 2021
Diana Kallberg Individual Operational/Managerial Control Jul 1, 2024
Adp of the SNF Jul 1, 2024
George Loban Individual Corporate DirectorBoard Member Jan 1, 2024
Adam Bachand Individual Corporate DirectorBoard Member Jan 1, 2025
Thomas Jamar Individual Corporate DirectorBoard Member Jan 1, 2023
Rebecca Urbanski Individual Corporate DirectorBoard Member Jan 1, 2025
Anthony Yung Individual Corporate DirectorBoard Member Jan 1, 2023
Essentia Health Organization, Duluth, MN Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2023 100%
Adp of the SNF Jan 28, 2025
Justin Terch Individual Corporate DirectorBoard Member Oct 22, 2025
St Marys Duluth Clinic Health System Organization, Duluth, MN Non-profit Operational/Managerial Control Jul 1, 2023
Adp of the SNF Jan 28, 2025
Kevin S Boren Individual Corporate OfficerVP of Finance Apr 4, 2022
Operational/Managerial Control Jul 1, 2023
Adp of the SNF Jul 1, 2023
Troy Duininck Individual Corporate DirectorBoard Member Jan 1, 2023
Michael Watters Individual Corporate OfficerSecretary Jul 1, 2023
Christopher T Whiting Individual Operational/Managerial Control Jan 1, 2024
Adp of the SNF Jan 1, 2024
Bruce Smith Individual Corporate DirectorBoard Member Jan 1, 2026
Nancy Aronson Norr Individual Corporate DirectorBoard Member Jan 1, 2025

Owners & managing parties with NPI records 6

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 46

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 46

Practitioners & affiliated clinicians

Practitioners 2

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.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708992000000",
    "number": "1063511020",
    "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": "218-229-2211",
            "fax_number": "218-229-2042"
        },
        {
            "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": "218-229-2211",
            "fax_number": "218-229-2042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN PINES MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESSENTIA HEALTH",
        "enumeration_date": "2006-09-22",
        "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": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063511020",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Northern Pines Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Essentia Health Northern Pines Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Aurora, MN

Sources for this page

Verify at the official NPI Registry.