Essentia Health Moose Lake
Organization Active NPI Critical Access Hospital · Moose Lake, MN
NPI 1154959880 · NPPES record last updated Feb 27, 2026
Key facts
- NPI
- 1154959880
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- Legal business name
- ESSENTIA HEALTH MOOSE LAKE
- Practice address
- 4572 County Road 61
Moose Lake, MN 55767-9401 - Phone
- (218) 485-4481
- NPI assigned
- Mar 30, 2020
- Organization subpart
- Yes
- Parent organization (as reported)
- ESSENTIA HEALTH
Authorized official
- Name
- Kevin Boren
- Title
- VP of Finance
- Phone
- (218) 786-1009
Owners & managing parties with NPI records 5
-
Troy M Duininck, MD
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 2
Related certifications (CCN) 1
Facilities with the same owner 46
Practitioners 287
-
Andrew Ames, M.D.
-
Matthew Mark Brabec, RN, CRNA
-
Janine M Cook, APRN, CNP
-
James J. Ryan, M.D.
-
Ashley Dianne Brown, M.D.
-
Brandi C Strong, M.D.
-
Amina Adil, MD
-
Brian Joseph Aebly, D.O.
-
Aleathea Rae Anderson, PA-C
-
Kristen Lee Anderson, CNP
-
Lisa Anne Arvold, M.D.
-
Adriana Nicole Askew, APRN, CRNA
-
Andrew John Ballard, APRN, CNP
-
Deviney Marie Benson, PA-C
Affiliated clinicians 177
-
Andrew Ames, M.D.
-
Aleathea Rae Anderson, PA-C
-
Gary T. Anderson, F.N.P.
-
Lisa Anne Arvold, M.D.
-
Joseph Arlo Benson, D.O.
-
Erin Elizabeth Beste, APRN, CNP
-
Kirsten I Bich, MD
-
Hannah Bjerkness, PA-C
-
Shawn F Bode, MD
-
Kathy H. Brandli, M.D.
-
Casey Simon Brock, P.A.
Medicare Care Compare: Hospital
- Listed as
- Essentia Health Moose Lake
- Type
- Critical Access Hospitals
- Ownership
- Government - Hospital District or Authority
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
Hospital certification: CCN 241350
- Legal name
- ESSENTIA HEALTH MOOSE LAKE
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Jan 1, 2004
- Last certification
- Aug 31, 2017
- Beds
- 25
- Ownership / control type
- Hospital district or authority
- Most recent change of ownership
- Aug 1, 2020 (1 total)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 6, 2020 in MN
- Enrollment address
- 4572 County Road 61
Moose Lake, MN 55767-9401
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| Krista Ann Skorupa |
Corporate Officer |
May 6, 2024 | |
| Amy Bergstrom |
Corporate Director |
Jan 1, 2024 | |
| Anthony Sertich |
Corporate Director |
Jan 1, 2021 | |
| George Loban |
Corporate Director |
Jan 1, 2024 | |
| Adam Bachand |
Corporate Officer |
Jan 1, 2025 | |
| Thomas Jamar |
Corporate Director |
Jan 1, 2023 | |
| Sam Barney |
W-2 Managing Employee |
Aug 23, 2023 | |
| Rebecca Urbanski |
Corporate Officer |
Jan 1, 2025 | |
| Anthony Yung |
Corporate Director |
Jan 1, 2023 | |
| Essentia Health |
5% Or Greater Direct Ownership Interest | Jul 1, 2023 | 100% |
| Justin Terch |
Corporate Director | Oct 22, 2025 | |
| St Marys Duluth Clinic Health System |
Operational/Managerial Control | Aug 1, 2020 | |
| Kevin S Boren |
Corporate Officer |
Oct 1, 2014 | |
| W-2 Managing Employee |
Oct 1, 2014 | ||
| Troy Duininck |
Corporate Director |
Jan 1, 2023 | |
| Michael Watters |
Corporate Officer |
Jul 1, 2023 | |
| Bruce Smith |
Corporate Director |
Jan 1, 2026 | |
| Nancy Aronson Norr |
Corporate Officer |
Jan 1, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200728000758 | MN | Part a Provider - Critical Access Hospital | 6608290333 |
Receives reassigned benefits from 240 practitioners 1 other NPI on this enrollment Practice locations: Moose Lake, MN |
| O20200730001548 | MN | Part B Supplier - Clinic/Group Practice | 6608290333 |
Receives reassigned benefits from 242 practitioners 1 other NPI on this enrollment Practice locations: Moose Lake, MN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Access Hospital | 282NC0060X | Yes |
Addresses
Primary practice location
4572 County Road 61
Moose Lake, MN 55767-9401
Mailing address
4572 County Road 61
Moose Lake, MN 55767-9401
Phone (218) 485-4481
Other names
- Essentia Health Moose Lake
Other providers in Moose Lake, MN
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- Steffany Drilling
- Tanya Eiffler
- Essentia Health Moose Lake
- Essentia Health Moose Lake
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All providers in Moose Lake, MN · Critical Access Hospital in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 27, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.