NPIMap

Organization Active NPI

Lake View Clinic

Doing business as Aspirus Lake View Two Harbors Clinic

  • Family Medicine Physician
  • Two Harbors, MN
National Provider Identifier
1548420037
Registry record updated Dec 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
331064 Issued in MN
Legal business name
LAKE VIEW CLINIC
Doing business as
Aspirus Lake View Two Harbors Clinic
Practice address
325 11TH Ave
Two Harbors, MN 55616-1300
Phone
(218) 834-7200
Fax
(218) 834-7220
NPI assigned
Jun 10, 2008
Last updated
Dec 15, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
LAKE VIEW MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 15, 2024

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

Authorized official

Name
Greg Garrett Ruberg
Title
President/Ceo
Phone
(218) 834-7345

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 331064 MN Primary

Addresses

Primary practice location

325 11TH Ave
Two Harbors, MN 55616-1300

Mailing address

325 11TH Ave
Two Harbors, MN 55616-1300
Phone (218) 834-7300

Other names 1

  • Aspirus Lake View Two Harbors Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040206000105 MN Part B Supplier - Clinic/Group Practice 9032002688 Receives reassigned benefits from 116 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Two Harbors, MN
O20061104000685 MN Part A Provider - Critical Access Hospital 9032002688 Receives reassigned benefits from 90 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Silver Bay, MN; Two Harbors, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1548420037. Details of each certification follow.

Hospital certification: CCN 241308

Legal name
LAKE VIEW MEMORIAL HOSPITAL, INC
Doing business as
ASPIRUS LAKE VIEW HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Nov 1, 2000
Last certification
May 2, 2024
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Nov 16, 1953 in MN
Enrollment address
325 11TH Ave
Two Harbors, MN 55616-1300
Main/Primary Hospital Location

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

Other NPIs on the same Medicare enrollment 5

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Aspirus Lake View HospitalCCN 241308 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D2324804Aspirus Lake View Two Harrbors Clinic325 11TH Ave, Two Harbors, MN 55616Certificate of waiverJun 1, 2027

National Provider Directory

National Provider Directory
Part of
Lake View Memorial Hospital

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
Richard Hogenson Individual Corporate DirectorBoard Member Jan 27, 2016
Jerry M Yang Individual Corporate OfficerSVP & Chief Financial Officer Mar 1, 2024
W-2 Managing EmployeeSVP & Chief Financial Officer Mar 1, 2024
Nathan J Cavallin Individual Corporate DirectorDirector-Finance Jun 1, 2017
W-2 Managing EmployeeDirector-Finance Jun 1, 2017
Kiera Marie Wilson Individual Corporate DirectorBoard Member May 26, 2021
Chris L Brelie Individual Corporate DirectorBoard Member May 26, 2021
Janelle Jones Individual Corporate DirectorBoard Member Jan 28, 2015
Aspirus, Inc Organization, Wausau, WI Corporation, Non-profit, Chain home office Operational/Managerial Control Mar 1, 2024
Greg G Ruberg Individual Corporate OfficerPresident/Ceo Jul 12, 2014
Kevin Beardsley Individual Corporate DirectorBoard Member Jan 1, 2010
St. Luke's Hospital of Duluth Organization, Duluth, MN 5% Or Greater Direct Ownership Interest Jan 1, 2010 100%
Joyce Scott Individual Corporate DirectorBoard Member May 20, 2020
Wade Leblanc Individual Corporate DirectorBoad Member Jun 1, 2012
Lori Peck Individual W-2 Managing EmployeeVP - Finance Mar 1, 2024
Kelsey M Schultz Individual Corporate OfficerBoard Member Apr 23, 2023
Tyler Hack Individual W-2 Managing EmployeeVP - Revenue Cycle Mar 1, 2024

Owners & managing parties with NPI records 10

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 14

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 14

Affiliated clinicians 149

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

View all 149

NPI Registry JSON

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

{
    "created_epoch": "1213056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734220800000",
    "number": "1548420037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 11TH AVE",
            "city": "TWO HARBORS",
            "state": "MN",
            "postal_code": "556161300",
            "telephone_number": "218-834-7300",
            "fax_number": "218-834-7388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 11TH AVE",
            "city": "TWO HARBORS",
            "state": "MN",
            "postal_code": "556161300",
            "telephone_number": "218-834-7200",
            "fax_number": "218-834-7220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE VIEW CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAKE VIEW MEMORIAL HOSPITAL",
        "enumeration_date": "2008-06-10",
        "last_updated": "2024-12-15",
        "certification_date": "2024-12-15",
        "status": "A",
        "authorized_official_last_name": "RUBERG",
        "authorized_official_first_name": "GREG",
        "authorized_official_middle_name": "GARRETT",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "218-834-7345"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "331064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aspirus Lake View Two Harbors Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Two Harbors, MN

Sources for this page

Verify at the official NPI Registry.