Deer River Healthcare Center, Inc.
Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Deer River, MN
NPI 1215041199 · NPPES record last updated Apr 7, 2022
Key facts
- NPI
- 1215041199
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medicare Defined Swing Bed Hospital Unit 275N00000X
- License
- 331194 (MN)
- Legal business name
- DEER RIVER HEALTHCARE CENTER, INC.
- Practice address
- 115 10TH Ave NE
Deer River, MN 56636-8795 - Phone
- (218) 246-2900
- Fax
- (218) 246-3057
- NPI assigned
- Aug 18, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- ST. MARY'S DULUTH CLINIC HEALTH SYSTEM
Authorized official
- Name
- Kevin Boren
- Title
- Cfo
- Phone
- (218) 786-1009
Owners & managing parties with NPI records 5
-
Troy M Duininck, MD
Other NPIs on the same Medicare enrollment 4
Other NPIs with the same Medicare PAC ID 2
Related certifications (CCN) 4
Facilities with the same owner 46
Practitioners 184
-
Eleanor E Jones, APRN,CNP
-
Stephanie L Alexander, APRN, CNP
-
Kristen Lee Anderson, CNP
-
Sharon Elizabeth Buesing, APRN, FNP
-
Wendy Lyn De la Cruz, APRN, CNP
-
Jared Evan Lund, M.D.
-
Desiree Anne Rohling, DNP, APRN, FNP-C
-
Karissa Marie Schultz, APRN, CNP
-
Gunther Wagoner, MD
-
Ryan Scott Watson, M.D.
-
Lee Thomas Church, M.D.
-
Brian Joseph Aebly, D.O.
-
Ashley G Aretz I, PA-C
-
Ramin Artang, MD
-
Lisa Anne Arvold, M.D.
-
Ganesh Asaithambi, M.D.
-
Zachary Thomas Barclay, PA-C
Affiliated clinicians 138
-
Brian Joseph Aebly, D.O.
-
Stephanie L Alexander, APRN, CNP
-
Alexandra Helen Atkinson, APRN, CNP
-
Joseph Arlo Benson, D.O.
-
Katherine Ann Beresford, M.D.
-
Kalkidan Genete Bishu, M.D.
-
Sonja M Bjerk, MD
-
April L Buescher, APRN,CNP
-
Sharon Elizabeth Buesing, APRN, FNP
-
Chelsea Lynn Upthegrove Casper, APRN, CNP
-
Lilian Chen, MD
-
Ryan Clark, M.D.
-
Emily Curran Day, FNP, RN, BSN
-
Wendy Lyn De la Cruz, APRN, CNP
-
Sreedhar Devathi, M.D.
-
Jenna Marie Dian, APRN, CNP
-
Kari Ann Drake, PA-C
Medicare Care Compare: Hospital
- Listed as
- Essentia Health Deer River
- Type
- Critical Access Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
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
- Corporation · Non-profit
- Enrollment address
- 115 10TH Ave NE
Deer River, MN 56636-8795
Hospital certification: CCN 24Z360
- Legal name
- DEER RIVER HEALTHCARE CENTER INC
- Doing business as
- ESSENTIA HEALTH DEER RIVER
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 115 10TH Ave NE
Deer River, MN 56636-8795
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 Officer |
Jan 1, 2021 | |
| George Loban |
Corporate Director |
Jan 1, 2024 | |
| Corporate Director | Jan 1, 2024 | ||
| Amanda Reed |
W-2 Managing Employee |
Jul 1, 2023 | |
| Adam Bachand |
Corporate Director |
Jan 1, 2025 | |
| Thomas Jamar |
Corporate Director |
Jan 1, 2023 | |
| Rebecca Urbanski |
Corporate Director |
Jan 1, 2025 | |
| Anthony Yung |
Corporate Director |
Jan 1, 2023 | |
| Essentia Health |
5% Or Greater Direct Ownership Interest | Mar 1, 2025 | 100% |
| Justin Terch |
Corporate Director |
Oct 22, 2025 | |
| St Marys Duluth Clinic Health System |
Operational/Managerial Control | Sep 1, 2012 | 100% |
| Kevin S Boren |
Corporate Officer |
Apr 4, 2022 | |
| W-2 Managing Employee | Jul 1, 2023 | ||
| W-2 Managing Employee |
Jul 1, 2023 | ||
| 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 Director |
Jan 1, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Part of
- St Marys Duluth Clinic Health System
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | 331194 | MN | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215041199 | Medicaid | MN | |
| 1604HCO | Other | MN | BLUE CROSS |
Other names
- Essentia Health Deer River
Other providers in Deer River, MN
- Deer River Healthcare Center Inc
- Deer River Healthcare Center Inc
- Deer River Healthcare Center Inc.
- Deer River Healthcare Center, Inc
- Deer River Healthcare Center, Inc
- Deer River Healthcare Center, Inc.
- Deer River Hired Hands, Inc.
- Kimberly Ann Deihl
- Thomas Dosen-Windorski
- Michaela Ashlyn Fairbanks
All providers in Deer River, MN · Medicare Defined Swing Bed Hospital Unit in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 7, 2022. 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.