NPIMap

Organization Active NPI

Deer River Healthcare Center, Inc.

Doing business as Essentia Health Deer River

  • Medicare Defined Swing Bed Hospital Unit
  • Deer River, MN
National Provider Identifier
1215041199
Registry record updated Apr 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
331194 Issued in MN
Legal business name
DEER RIVER HEALTHCARE CENTER, INC.
Doing business as
Essentia Health Deer River
Practice address
115 10TH Ave NE
Deer River, MN 56636-8795
Phone
(218) 246-2900
Fax
(218) 246-3057
NPI assigned
Aug 18, 2006
Last updated
Apr 7, 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 Apr 7, 2022

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

Authorized official

Name
Kevin Boren
Title
Cfo
Phone
(218) 786-1009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 331194 MN Primary

Addresses

Primary practice location

115 10TH Ave NE
Deer River, MN 56636-8795

Mailing address

115 10TH Ave NE
Deer River, MN 56636-8795
Phone (218) 246-2900

Other names 1

  • Essentia Health Deer River Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20061104000444 MN Part A Provider - Critical Access Hospital 1850388448 Receives reassigned benefits from 176 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Deer River, MN
O20080430000308 MN Part A Provider - Critical Access Hospital 1850388448 Receives reassigned benefits from 1 practitioner
Practice locations: Deer River, MN

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1215041199. Details of each certification follow.

Hospital certification: CCN 241360

Legal name
DEER RIVER HEALTHCARE CENTER INC
Doing business as
ESSENTIA HEALTH DEER RIVER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Dec 1, 2004
Last certification
Jun 27, 2024
Beds
20
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
115 10TH Ave NE
Deer River, MN 56636-8795
Main/Primary Hospital Location

Hospital certification: CCN 24Z360

Legal name
DEER RIVER HEALTHCARE CENTER INC
Doing business as
ESSENTIA HEALTH DEER RIVER
Organization structure
CorporationNon-profit
Enrollment address
115 10TH Ave NE
Deer River, MN 56636-8795
Main/Primary Hospital 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 4

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Essentia Health Deer RiverCCN 241360 · 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 Marys Duluth Clinic Health System

Locations

1542 Golf Course Rd
Ste 202
Grand Rapids, MN 55744
Phone (218) 327-7973

1542 Golf Course Rd
Ste 203
Grand Rapids, MN 55744
Phone (218) 322-4900

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 OfficerBoard Member Jan 1, 2021
George Loban Individual Corporate DirectorBoard Member Jan 1, 2024
Corporate Director Jan 1, 2024
Amanda Reed Individual W-2 Managing EmployeeAd; Jul 1, 2023
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 Mar 1, 2025 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, 2012 100%
Kevin S Boren Individual Corporate OfficerVP of Finance Apr 4, 2022
W-2 Managing Employee Jul 1, 2023
W-2 Managing EmployeeVP of Finance Jul 1, 2023
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 184

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 184

Affiliated clinicians 138

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

View all 138

NPI Registry JSON

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649289600000",
    "number": "1215041199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 10TH AVE NE",
            "city": "DEER RIVER",
            "state": "MN",
            "postal_code": "566368795",
            "telephone_number": "218-246-2900",
            "fax_number": "218-246-3057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 10TH AVE NE",
            "city": "DEER RIVER",
            "state": "MN",
            "postal_code": "566368795",
            "telephone_number": "218-246-2900",
            "fax_number": "218-246-3057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEER RIVER HEALTHCARE CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. MARY'S DULUTH CLINIC HEALTH SYSTEM",
        "enumeration_date": "2006-08-18",
        "last_updated": "2022-04-07",
        "certification_date": "2022-04-07",
        "status": "A",
        "authorized_official_last_name": "BOREN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "218-786-1009"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "MN",
            "license": "331194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Deer River",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Essentia Health Deer River",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Deer River, MN

Sources for this page

Verify at the official NPI Registry.