NPIMap

Organization Active NPI

Pine Medical Center

Doing business as Essentia Health Sandstone

  • Medicare Defined Swing Bed Hospital Unit
  • Sandstone, MN
National Provider Identifier
1205043841
Registry record updated Feb 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
361349 Issued in MN
Legal business name
PINE MEDICAL CENTER
Doing business as
Essentia Health Sandstone
Practice address
705 Lundorff Drive South
Sandstone, MN 55072
Phone
(320) 245-2212
Fax
(320) 245-3251
NPI assigned
May 16, 2007
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
Medicare Defined Swing Bed Hospital Unit 275N00000X 361349 MN Primary

Addresses

Primary practice location

705 Lundorff Drive South
Sandstone, MN 55072

Mailing address

705 Lundorff Drive South
Sandstone, MN 55072
Phone (320) 245-2212

Other identifiers 1

IdentifierTypeStateIssuer
1205043841MedicaidMN

Other names 1

  • Essentia Health Sandstone Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080430000545 MN Part A Provider - Critical Access Hospital 3870406945 Receives reassigned benefits from 2 practitioners
Practice locations: Sandstone, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205043841. Details of each certification follow.

Hospital certification: CCN 24Z309

Legal name
PINE MEDICAL CENTER
Doing business as
ESSENTIA HEALTH SANDSTONE
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 1997 in MS
Enrollment address
705 Lundorff Dr
Sandstone, MN 55072-5099

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

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
SMDC Pine Medical Cente5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

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

Ownership & related parties

All disclosed owners & managing parties 16

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 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%
Justin Terch Individual Corporate Director 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 DirectorBoard Member 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.

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 3

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": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708992000000",
    "number": "1205043841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 LUNDORFF DRIVE SOUTH",
            "city": "SANDSTONE",
            "state": "MN",
            "postal_code": "55072",
            "telephone_number": "320-245-2212",
            "fax_number": "320-245-3251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 LUNDORFF DRIVE SOUTH",
            "city": "SANDSTONE",
            "state": "MN",
            "postal_code": "55072",
            "telephone_number": "320-245-2212",
            "fax_number": "320-245-3251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESSENTIA HEALTH",
        "enumeration_date": "2007-05-16",
        "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": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "MN",
            "license": "361349",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1205043841",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Sandstone",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Essentia Health Sandstone",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sandstone, MN

Sources for this page

Verify at the official NPI Registry.