NPIMap

Organization Active NPI

Essentia Health Moose Lake

  • Critical Access Hospital
  • Moose Lake, MN
National Provider Identifier
1154959880
Registry record updated Feb 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
ESSENTIA HEALTH MOOSE LAKE
Doing business as
Essentia Health Moose Lake
Practice address
4572 County Road 61
Moose Lake, MN 55767-9401
Phone
(218) 485-4481
NPI assigned
Mar 30, 2020
Last updated
Feb 27, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
ESSENTIA HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 27, 2026

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
Critical Access Hospital 282NC0060X Primary

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 1

  • Essentia Health Moose Lake Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154959880. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Mar 6, 2020 in MN
Enrollment address
4572 County Road 61
Moose Lake, MN 55767-9401
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 2

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

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 Moose LakeCCN 241350 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Member of 1

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

Ownership & related parties

All disclosed owners & managing parties 17

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
George Loban Individual Corporate DirectorBoard Member Jan 1, 2024
Adam Bachand Individual Corporate OfficerBoard Member Jan 1, 2025
Thomas Jamar Individual Corporate DirectorBoard Member Jan 1, 2023
Sam Barney Individual W-2 Managing EmployeeAdministrator Aug 23, 2023
Rebecca Urbanski Individual Corporate OfficerBoard 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 Director Oct 22, 2025
St Marys Duluth Clinic Health System Organization, Duluth, MN Non-profit Operational/Managerial Control Aug 1, 2020
Kevin S Boren Individual Corporate OfficerVP of Finance Oct 1, 2014
W-2 Managing EmployeeVP of Finance Oct 1, 2014
Troy Duininck Individual Corporate DirectorBoard Member Jan 1, 2023
Michael Watters Individual Corporate OfficerSecretary Jul 1, 2023
Bruce Smith Individual Corporate DirectorBoard Member Jan 1, 2026
Nancy Aronson Norr Individual Corporate OfficerBoard 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.

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 287

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.

View all 287

Affiliated clinicians 177

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

View all 177

NPI Registry JSON

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

{
    "created_epoch": "1585526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772150400000",
    "number": "1154959880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4572 COUNTY ROAD 61",
            "city": "MOOSE LAKE",
            "state": "MN",
            "postal_code": "557679401",
            "telephone_number": "218-485-4481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4572 COUNTY ROAD 61",
            "city": "MOOSE LAKE",
            "state": "MN",
            "postal_code": "557679401",
            "telephone_number": "218-485-4481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESSENTIA HEALTH MOOSE LAKE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESSENTIA HEALTH",
        "enumeration_date": "2020-03-30",
        "last_updated": "2026-02-27",
        "certification_date": "2026-02-27",
        "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": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Moose Lake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moose Lake, MN

Sources for this page

Verify at the official NPI Registry.