NPIMap

Organization Active NPI

Pine Medical Center

Doing business as Essentia Health Emergency Medical Services-Sandstone

  • Ambulance
  • Sandstone, MN
National Provider Identifier
1154852937
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
AmbulanceTaxonomy code 341600000X
License
0195 Issued in MN
Legal business name
PINE MEDICAL CENTER
Doing business as
Essentia Health Emergency Medical Services-Sandstone
Practice address
705 Lundorff Dr
Sandstone, MN 55072-5099
Phone
(320) 245-2211
NPI assigned
Mar 23, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
ST MARY'S DULUTH CLINIC HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Michael Hedrix
Title
Administrator
Phone
(320) 245-5605

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulance 341600000X 0195 MN Primary
Ambulance 341600000X 1967 MN

Addresses

Primary practice location

705 Lundorff Dr
Sandstone, MN 55072-5099

Mailing address

705 Lundorff Drive
Sandstone, MN 55072-5120
Phone (320) 245-2211

Other practice location 1

109 Court Ave S
Sandstone, MN 55072-5120
Phone (320) 245-2211

Other names 1

  • Essentia Health Emergency Medical Services-Sandstone Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061104000642 MN Part A Provider - Critical Access Hospital 3870406945 Receives reassigned benefits from 132 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sandstone, MN; Hinckley, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154852937. Details of each certification follow.

Hospital certification: CCN 241309

Legal name
PINE MEDICAL CENTER
Doing business as
ESSENTIA HEALTH SANDSTONE
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Nov 1, 2000
Last certification
Jul 9, 2025
Beds
35 (25 certified)
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 1997 in MN
Enrollment address
705 Lundorff Dr
Sandstone, MN 55072-5099

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Essentia Health SandstoneCCN 241309 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Part of
St Mary's Duluth Clinic Health System

Ownership & related parties

All disclosed owners & managing parties 15

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
Anthony Sertich Individual Corporate DirectorBoard Member Jan 1, 2021
Adam Bachand Individual Corporate DirectorBoard Member Jan 1, 2025
Thomas Jamar Individual Corporate DirectorBoard Member Jan 1, 2023
Sam Barney Individual W-2 Managing EmployeeAdministrator Aug 28, 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%
Justin Terch Individual Corporate DirectorBoard Member Oct 22, 2025
St Marys Duluth Clinic Health System Organization, Duluth, MN Non-profit Operational/Managerial Control Sep 1, 1997 100%
Kevin S Boren Individual Corporate OfficerVP of Finance Aug 30, 2021
W-2 Managing EmployeeVP of Finance Aug 30, 2021
Troy Duininck Individual Corporate DirectorBoard Member Jan 1, 2023
Michael Watters Individual Corporate OfficerSecretary Jul 1, 2023
Bruce Smith Individual Corporate Director Jan 1, 2026
Nancy Aronson Norr Individual Corporate DirectorBoard Member Jan 1, 2025

Owners & managing parties with NPI records 5

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

Practitioners & affiliated clinicians

Affiliated clinicians 86

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

View all 86

NPI Registry JSON

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

{
    "created_epoch": "1490227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1154852937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 LUNDORFF DRIVE",
            "city": "SANDSTONE",
            "state": "MN",
            "postal_code": "550725120",
            "telephone_number": "320-245-2211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 LUNDORFF DR",
            "city": "SANDSTONE",
            "state": "MN",
            "postal_code": "550725099",
            "telephone_number": "320-245-2211"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "109 Court Ave S",
            "address_purpose": "LOCATION",
            "city": "Sandstone",
            "state": "MN",
            "postal_code": "550725120",
            "country_code": "US",
            "telephone_number": "320-245-2211",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PINE MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST MARY'S DULUTH CLINIC HEALTH SYSTEM",
        "enumeration_date": "2017-03-23",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "HEDRIX",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "320-245-5605"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "MN",
            "license": "0195",
            "primary": true
        },
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "MN",
            "license": "1967",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Emergency Medical Services-Sandstone",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sandstone, MN

Sources for this page

Verify at the official NPI Registry.