NPIMap

Organization Active NPI

Northern Lakes Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Moose Lake, MN
National Provider Identifier
1649922485
Registry record updated Mar 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
NORTHERN LAKES SURGERY CENTER LLC
Doing business as
Northern Lakes Surgery Center LLC
Practice address
4791 County Road 10
Moose Lake, MN 55767-9221
Phone
(218) 249-5357
NPI assigned
Jan 24, 2022
Last updated
Mar 11, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2026

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

Authorized official

Name
Lori Peck
Title
SVP- Chief Financial Officer
Phone
(715) 847-2575

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

4791 County Road 10
Moose Lake, MN 55767-9221

Mailing address

915 E 1St St
Duluth, MN 55805-2107

Other names 1

  • NORTHERN LAKES SURGERY CENTER LLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230525002232 MN Part B Supplier - Ambulatory Surgical Center 1850757311 Receives reassigned benefits from 5 practitioners
Practice locations: Moose Lake, MN

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Northern Lakes Surgery Center LLCCCN 24C0001118
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Northern Lake Surgery Center DME3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Member of 1

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

Locations

L4321
Columbus, OH 43260

Interoperability endpoints

  • Direct secure messaging: curtis.kristensen.kricu@nls.direct.slhduluth.com
  • Direct secure messaging: james.mach.machja@nls.direct.slhduluth.com
  • Direct secure messaging: mariya.skube.skuma@nls.direct.slhduluth.com

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1642982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773187200000",
    "number": "1649922485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 E 1ST ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4791 COUNTY ROAD 10",
            "city": "MOOSE LAKE",
            "state": "MN",
            "postal_code": "557679221",
            "telephone_number": "218-249-5357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN LAKES SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-24",
        "last_updated": "2026-03-11",
        "certification_date": "2026-03-11",
        "status": "A",
        "authorized_official_last_name": "PECK",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "SVP- CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "715-847-2575"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTHERN LAKES SURGERY CENTER LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moose Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2026; 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.