NPIMap

Organization Active NPI

Essentia Health Virginia, LLC

Doing business as Essentia Health Virginia Care Center

  • Skilled Nursing Facility
  • Virginia, MN
National Provider Identifier
1396748034
Registry record updated Apr 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
324847 Issued in MN
Legal business name
ESSENTIA HEALTH VIRGINIA, LLC
Doing business as
Essentia Health Virginia Care Center
Practice address
901 9TH St N
Virginia, MN 55792-2348
Phone
(218) 741-3340
Fax
(218) 749-9427
NPI assigned
May 26, 2005
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
Samuel Stone
Title
Coo
Phone
(218) 749-9496

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 324847 MN Primary

Addresses

Primary practice location

901 9TH St N
Virginia, MN 55792-2348

Mailing address

901 9TH St N
Virginia, MN 55792-2348
Phone (218) 741-3340

Other identifiers 1

IdentifierTypeStateIssuer
936325400MedicaidMN

Other names 1

  • Essentia Health Virginia Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121217000157 MN Part A Provider - Skilled Nursing Facility 7810149002 Practice locations: Virginia, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396748034. Details of each certification follow.

Skilled nursing facility certification: CCN 245458

Legal name
ESSENTIA HEALTH VIRGINIA LLC
Doing business as
ESSENTIA HEALTH VIRGINIA CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 1, 1987
Last certification
Jan 9, 2025
Beds
40
Ownership / control type
Nonprofit Corporation
Organization structure
LLCNon-profit
Incorporated
Aug 28, 2012 in DE
Enrollment address
901 9TH St N
Virginia, MN 55792-2325
Nursing home name
ESSENTIA HEALTH VIRGINIA CARE CENT
Affiliated entity
ESSENTIA HEALTH

Other NPIs with the same Medicare PAC ID 3

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Essentia Health Virginia Care CentCCN 245458 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Apr 1, 1987
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
4016.6 residents per day on average
Chain
Essentia Health6 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Essentia Health Virginia LLC7 organizations share this tax ID, including this one
Part of
St Mary's Duluth Clinic Health System

Other organizations with this tax ID 6

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

Member of 3

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

Ownership & related parties

All disclosed owners & managing parties 22

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
Mark Bortnem Individual Corporate OfficerTreasurer Sep 29, 2025
Amy Bergstrom Individual Managing Control - Governing BodyBoard Member Jan 1, 2025
Anthony Sertich Individual Managing Control - Governing BodyBoard Member Jan 1, 2021
George Loban Individual Managing Control - Governing BodyBoard Member Jan 1, 2024
Adam Bachand Individual Managing Control - Governing BodyBoard Member Jan 1, 2025
Thomas Jamar Individual Managing Control - Governing BodyBoard Member Jan 1, 2023
Deborah Meyer Individual Operational/Managerial Control Sep 9, 2023
Adp of the SNF Sep 9, 2023
Rebecca Urbanski Individual Managing Control - Governing BodyBoard Member Jan 1, 2025
Anthony Yung Individual Corporate Director Jan 1, 2023
Managing Control - Governing BodyBoard Member Jan 1, 2023
Essentia Health Organization, Duluth, MN Non-profit 5% Or Greater Indirect Ownership Interest Aug 28, 2012 100%
Adp of the SNF Oct 28, 2025
Indirect Ownership Interest Aug 28, 2012 100%
Beverly Raway Individual Managing Control - Governing BodyBoard Member Oct 1, 2018
St Marys Duluth Clinic Health System Organization, Duluth, MN Non-profit Operational/Managerial Control Aug 28, 2012
Adp of the SNF Oct 28, 2025
Bradley J Beard Individual Corporate OfficerChief Operating Officer Jul 1, 2023
Operational/Managerial Control Jul 1, 2023
Adp of the SNF Jul 1, 2023
Jeanne Weber Individual Managing Control - Governing BodyBoard Member Feb 15, 2019
Kevin S Boren Individual Corporate OfficerVP of Finance Jul 1, 2023
Operational/Managerial Control Jul 1, 2023
Adp of the SNF Jul 1, 2023
Troy Duininck Individual Managing Control - Governing BodyBoard Member Jan 1, 2023
SMDC Medical Center Organization, Duluth, MN Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Aug 28, 2012 100%
Direct Ownership Interest Jul 1, 2012 100%
Michael Watters Individual Corporate OfficerSecretary Jul 1, 2023
Michelle Renee Oman Individual Operational/Managerial Control Jan 1, 2024
Adp of the SNF Jan 1, 2024
Jan Linse Baldwin Individual Managing Control - Governing BodyBoard Member Jan 1, 2017
Nancy Aronson Norr Individual Managing Control - Governing BodyBoard Member Jan 1, 2025

Owners & managing parties with NPI records 8

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 3

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 1

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": "1117065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649289600000",
    "number": "1396748034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 9TH ST N",
            "city": "VIRGINIA",
            "state": "MN",
            "postal_code": "557922348",
            "telephone_number": "218-741-3340",
            "fax_number": "218-749-9427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 9TH ST N",
            "city": "VIRGINIA",
            "state": "MN",
            "postal_code": "557922348",
            "telephone_number": "218-741-3340",
            "fax_number": "218-749-9427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESSENTIA HEALTH VIRGINIA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. MARY'S DULUTH CLINIC HEALTH SYSTEM",
        "enumeration_date": "2005-05-26",
        "last_updated": "2022-04-07",
        "certification_date": "2022-04-07",
        "status": "A",
        "authorized_official_last_name": "STONE",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "218-749-9496"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": "324847",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "936325400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Virginia Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Essentia Health Virginia Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Virginia, MN

Sources for this page

Verify at the official NPI Registry.