NPIMap

Organization Active NPI

Pine Medical Center

Doing business as Essentia Health Sandstone

  • Critical Access Hospital
  • Sandstone, MN
National Provider Identifier
1326041633
Registry record updated Feb 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
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 31, 2005
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
Mr. Kevin Boren
Title
VP of Finance
Phone
(218) 786-1009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 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 14

IdentifierTypeStateIssuer
6604104OtherMNMEDICA URGENT CARE
01006123OtherMNPREFERRED ONE ER
1033994OtherMNPREFERRED ONE UC
1326041633MedicaidWI
5013818OtherMNMEDICA UB
300142OtherMNUCARE AMBULANCE
3945005OtherMNMEDICA ER
3B24HPIOtherMNBCBS OF MINNESOTA UB
22454NOOtherMNBCBS OF MINNESOTA ER
H109OtherMNUCARE ER
F793OtherMNUCARE UC
1326041633MedicaidMN
36F55PIOtherMNBCBS OF MINNESOTA UC
58444OtherMNHEALTH PARTNERS

Other names 1

  • Essentia Health Sandstone Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031106000272 MN Part B Supplier - Clinic/Group Practice 3870406945 Receives reassigned benefits from 185 practitioners
1 other NPI on this enrollment
Practice locations: Hinckley, MN; Sandstone, MN
O20061104000642 MN Part A Provider - Critical Access Hospital 3870406945 Receives reassigned benefits from 132 practitioners
1 other NPI on this enrollment
Practice locations: Sandstone, MN; Hinckley, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1326041633. Details of each certification follow.

Hospital certification: CCN 241309

Legal name
PINE MEDICAL CENTER
Doing business as
ESSENTIA HEALTH SANDSTONE
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Nov 1, 2000
Last certification
Jul 9, 2025
Beds
35 (25 certified)
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 1997 in MN
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).

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Essentia Health SandstoneCCN 241309 · 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

Member of 1

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

Ownership & related parties

All disclosed owners & managing parties 15

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
Anthony Sertich Individual Corporate DirectorBoard Member Jan 1, 2021
Adam Bachand Individual Corporate DirectorBoard Member Jan 1, 2025
Thomas Jamar Individual Corporate DirectorBoard Member Jan 1, 2023
Sam Barney Individual W-2 Managing EmployeeAdministrator Aug 28, 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 DirectorBoard Member 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 Director 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 212

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 212

Affiliated clinicians 86

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

View all 86

NPI Registry JSON

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

{
    "created_epoch": "1117497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708992000000",
    "number": "1326041633",
    "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": "2005-05-31",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MN",
            "license": "361349",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA URGENT CARE",
            "identifier": "6604104",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE ER",
            "identifier": "01006123",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE UC",
            "identifier": "1033994",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1326041633",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA UB",
            "identifier": "5013818",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE AMBULANCE",
            "identifier": "300142",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA ER",
            "identifier": "3945005",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MINNESOTA UB",
            "identifier": "3B24HPI",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MINNESOTA ER",
            "identifier": "22454NO",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE ER",
            "identifier": "H109",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE UC",
            "identifier": "F793",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1326041633",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MINNESOTA UC",
            "identifier": "36F55PI",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "58444",
            "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.