NPIMap

Organization Active NPI

Brainerd Medical Center Inc

Doing business as Essentia Health Deerwood Pharmacy

  • Community/Retail Pharmacy
  • Deerwood, MN
National Provider Identifier
1477253045
Registry record updated Jul 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
BRAINERD MEDICAL CENTER INC
Doing business as
Essentia Health Deerwood Pharmacy
Practice address
24087 Cuyuna St
Ste 100
Deerwood, MN 56444
Phone
(218) 833-5170
Fax
(218) 833-5171
NPI assigned
Mar 3, 2023
Last updated
Jul 3, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ESSENTIA HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 3, 2024

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

Authorized official

Name
Kevin Boren
Title
VP of Finance
Phone
(218) 786-1009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

24087 Cuyuna St
Ste 100
Deerwood, MN 56444

Mailing address

PO Box 518
Deerwood, MN 56444-0518
Phone (218) 833-5170

Other names 1

  • Essentia Health Deerwood Pharmacy Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20171013000866 MN Part B Supplier - Mass Immunization (Roster Biller Only) 0648270272 6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Baxter, MN; Brainerd, MN; Deerwood, MN; Pequot Lakes, MN; Pine River, MN; Staples, MN
O20230824003147 MN DME Supplier - Pharmacy 0648270272 Practice locations: Deerwood, MN

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 6

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Essentia Health Deerwood Pharmacy24087 Cuyuna St, Deerwood, MN 56444-3301(218) 833-5170 Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) Accepts assignmentParticipating since Jan 2, 2007

National Provider Directory

National Provider Directory
Tax ID family
Brainerd Medical Center Inc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

24087 Cuyuna St
#100
Deerwood, MN 56444
Phone (218) 833-5170

204 Belknap St
Superior, WI 54880
Phone (218) 576-0842

NPI Registry JSON

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

{
    "created_epoch": "1677801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719964800000",
    "number": "1477253045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 518",
            "city": "DEERWOOD",
            "state": "MN",
            "postal_code": "564440518",
            "telephone_number": "218-833-5170",
            "fax_number": "218-833-5169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24087 CUYUNA ST",
            "address_2": "STE 100",
            "city": "DEERWOOD",
            "state": "MN",
            "postal_code": "56444",
            "telephone_number": "218-833-5170",
            "fax_number": "218-833-5171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAINERD MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESSENTIA HEALTH",
        "enumeration_date": "2023-03-03",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "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"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Deerwood Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Essentia Health Deerwood Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Deerwood, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.