NPIMap

Organization Active NPI

Pine Medical Center

Doing business as Essentia Health Hinckley Clinic

  • Multi-Specialty Clinic/Center
  • Hinckley, MN
National Provider Identifier
1720859531
Registry record updated Feb 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
PINE MEDICAL CENTER
Doing business as
Essentia Health Hinckley Clinic
Practice address
45 Lady Luck Dr
Hinckley, MN 55037-6419
Phone
(320) 279-8600
Fax
(320) 279-8601
NPI assigned
Jan 10, 2024
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
Bradley Beard
Title
Coo
Phone
(218) 786-5652

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

45 Lady Luck Dr
Hinckley, MN 55037-6419

Mailing address

45 Lady Luck Dr
Hinckley, MN 55037-6419
Phone (320) 279-8600

Other names 1

  • Essentia Health Hinckley Clinic Doing business as

Medicare participation

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

Enrollment records 1

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
This NPI is an additional NPI on the enrollment
Practice locations: Hinckley, MN; Sandstone, MN

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Member of 1

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

Practitioners & affiliated clinicians

Practitioners 181

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 181

NPI Registry JSON

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

{
    "created_epoch": "1704844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708992000000",
    "number": "1720859531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 LADY LUCK DR",
            "city": "HINCKLEY",
            "state": "MN",
            "postal_code": "550376419",
            "telephone_number": "320-279-8600",
            "fax_number": "320-279-8601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 LADY LUCK DR",
            "city": "HINCKLEY",
            "state": "MN",
            "postal_code": "550376419",
            "telephone_number": "320-279-8600",
            "fax_number": "320-279-8601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESSENTIA HEALTH",
        "enumeration_date": "2024-01-10",
        "last_updated": "2024-02-27",
        "certification_date": "2024-02-27",
        "status": "A",
        "authorized_official_last_name": "BEARD",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "218-786-5652"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Hinckley Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Essentia Health Hinckley Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hinckley, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.