NPIMap

Organization Active NPI

Deer River Healthcare Center, Inc

Doing business as Essentia Health Emergency Medical Services-Deer River

  • Ambulance
  • Deer River, MN
National Provider Identifier
1295266898
Registry record updated May 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
AmbulanceTaxonomy code 341600000X
License
0064 Issued in MN
Legal business name
DEER RIVER HEALTHCARE CENTER, INC
Doing business as
Essentia Health Emergency Medical Services-Deer River
Practice address
115 10TH Ave NE
Deer River, MN 56636-8795
Phone
(218) 246-2900
NPI assigned
Mar 24, 2017
Last updated
May 20, 2019By 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 May 20, 2019

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

Authorized official

Name
Steven Feltman
Title
Cfo
Phone
(218) 742-8662

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulance 341600000X 0064 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 Emergency Medical Services-Deer River Doing business as

Medicare participation

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

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295266898. 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

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

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

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
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
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.

Practitioners & affiliated clinicians

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": "1490313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558310400000",
    "number": "1295266898",
    "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"
        },
        {
            "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"
        }
    ],
    "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": "2017-03-24",
        "last_updated": "2019-05-20",
        "status": "A",
        "authorized_official_last_name": "FELTMAN",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "218-742-8662"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "MN",
            "license": "0064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Emergency Medical Services-Deer River",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Essentia Health Emergency Medical Services-Deer River",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Deer River, MN

Sources for this page

Verify at the official NPI Registry.