NPIMap

Organization Active NPI

Cook County Hospital District

Doing business as Cook County North Shore Hospital and Care Center

  • Medicare Defined Swing Bed Hospital Unit
  • Grand Marais, MN
National Provider Identifier
1780743674
Registry record updated Nov 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
330902 Issued in MN
Legal business name
COOK COUNTY HOSPITAL DISTRICT
Doing business as
Cook County North Shore Hospital and Care Center
Practice address
515 5TH Ave W
Grand Marais, MN 55604-3017
Phone
(218) 387-3040
NPI assigned
Dec 6, 2006
Last updated
Nov 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2024

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

Authorized official

Name
Kimber Wraalstad
Title
Ceo/Administrator
Phone
(218) 387-3260

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 330902 MN Primary

Addresses

Primary practice location

515 5TH Ave W
Grand Marais, MN 55604-3017

Mailing address

515 5TH Ave W
Grand Marais, MN 55604-3017
Phone (218) 387-3040

Other identifiers 2

IdentifierTypeStateIssuer
1658HCOOtherMNBCBS OF MN
3657451000MedicaidMN

Other names 1

  • Cook County North Shore Hospital and 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
O20100603000871 MN Part A Provider - Critical Access Hospital 4284629742 Receives reassigned benefits from 1 practitioner
Practice locations: Grand Marais, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780743674. Details of each certification follow.

Hospital certification: CCN 24Z317

Legal name
COOK COUNTY HOSPITAL DISTRICT
Doing business as
NORTH SHORE HEALTH
Organization structure
GovernmentNon-profit
Enrollment address
515 5TH Ave W
Grand Marais, MN 55604-3017
Hospital Swing-Bed Unit

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

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Cook County Hospital District4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Paul Edward Goettl Individual Operational/Managerial ControlCfo Jul 13, 2020
Kimber L Wraalstad Individual Corporate OfficerAdministrator Aug 23, 2010
Operational/Managerial ControlAdministrator Aug 23, 2010
Cook County Hospital District Organization, Grand Marais, MN Operational/Managerial Control Mar 3, 2010

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
North Shore HealthGrand Marais, MN, CCN 241317 Hospital Operational/Managerial Control Sep 4, 2009
North Shore HealthGrand Marais, MN, CCN 245384 Skilled nursing facility Operational/Managerial Control (100%) Jan 1, 1987
North Shore HealthGrand Marais, MN, CCN 247004 Home health agency 5% Or Greater Direct Ownership Interest Jan 1, 1996

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 1

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 3

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": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730419200000",
    "number": "1780743674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 5TH AVE W",
            "city": "GRAND MARAIS",
            "state": "MN",
            "postal_code": "556043017",
            "telephone_number": "218-387-3040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 5TH AVE W",
            "city": "GRAND MARAIS",
            "state": "MN",
            "postal_code": "556043017",
            "telephone_number": "218-387-3040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOK COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2024-11-01",
        "certification_date": "2024-11-01",
        "status": "A",
        "authorized_official_last_name": "WRAALSTAD",
        "authorized_official_first_name": "KIMBER",
        "authorized_official_title_or_position": "CEO/ADMINISTRATOR",
        "authorized_official_telephone_number": "218-387-3260"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "MN",
            "license": "330902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN",
            "identifier": "1658HCO",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3657451000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cook County North Shore Hospital and Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Marais, MN

Sources for this page

Verify at the official NPI Registry.