NPIMap

Organization Active NPI

Northern Pines Medical Center

Doing business as Essentia Health Northern Pines Clinic

  • Critical Access Hospital Clinic/Center
  • Aurora, MN
National Provider Identifier
1881954147
Registry record updated Oct 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access Hospital Clinic/CenterTaxonomy code 261QC0050X
License
00604 Issued in MN
Legal business name
NORTHERN PINES MEDICAL CENTER
Doing business as
Essentia Health Northern Pines Clinic
Practice address
5211 Highway 110
Aurora, MN 55705-1522
Phone
(218) 229-2211
NPI assigned
May 21, 2012
Last updated
Oct 18, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
ST. MARY'S DULUTH CLINIC HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 18, 2013

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

Authorized official

Name
Laura J Ackman
Title
Ceo
Phone
(218) 229-4222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital Clinic/Center 261QC0050X 00604 MN Primary

Addresses

Primary practice location

5211 Highway 110
Aurora, MN 55705-1522

Mailing address

5211 Highway 110
Aurora, MN 55705-1522
Phone (218) 229-2211

Other identifiers 1

IdentifierTypeStateIssuer
1881954147MedicaidMN

Other names 1

  • Essentia Health Northern Pines 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
O20040811000988 MN Part B Supplier - Clinic/Group Practice 3870565641 Receives reassigned benefits from 144 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Aurora, MN
O20090603000087 MN Part A Provider - Critical Access Hospital 3870565641 Receives reassigned benefits from 122 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Aurora, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881954147. Details of each certification follow.

Hospital certification: CCN 241340

Legal name
NORTHERN PINES MEDICAL CENTER
Doing business as
ESSENTIA HEALTH NORTHERN PINES
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jul 1, 2002
Last certification
May 15, 2024
Beds
16
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
5211 Highway 110
Aurora, MN 55705-1522
Other Hospital Practice Location

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

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Essentia Health Northern Pines Medical CenterCCN 241340 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Part of
St Mary's Duluth Clinic Health System

Member of 1

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

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Krista Ann Skorupa Individual Corporate OfficerPresident May 6, 2024
Amy Bergstrom Individual Corporate DirectorBoard Member Jan 1, 2024
Diana Kallberg Individual W-2 Managing EmployeeAd; Jul 1, 2024
George Loban Individual Corporate DirectorBoard Member Jan 1, 2024
Adam Bachand Individual Corporate OfficerBoard Member Jan 1, 2025
Thomas Jamar Individual Corporate DirectorBoard Member Jan 1, 2023
Rebecca Urbanski Individual Corporate OfficerBoard Member Jan 1, 2025
Anthony Yung Individual Corporate DirectorBoard Member Jan 1, 2023
Essentia Health Organization, Duluth, MN Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2023 100%
Justin Terch Individual Corporate DirectorBoard Member Oct 22, 2025
St Marys Duluth Clinic Health System Organization, Duluth, MN Non-profit Operational/Managerial Control Jul 1, 2010
Kevin S Boren Individual Corporate OfficerVP of Finance Jul 1, 2023
W-2 Managing EmployeeVP of Finance Jul 1, 2023
Troy Duininck Individual Corporate DirectorBoard Member Jan 1, 2023
Michael Watters Individual Corporate OfficerSecretary Jul 1, 2023
Bruce Smith Individual Corporate DirectorBoard Member Jan 1, 2026
Nancy Aronson Norr Individual Corporate OfficerBoard Member Jan 1, 2025

Owners & managing parties with NPI records 5

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

Practitioners & affiliated clinicians

Practitioners 29

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 29

Affiliated clinicians 77

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

View all 77

NPI Registry JSON

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

{
    "created_epoch": "1337558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382054400000",
    "number": "1881954147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5211 HIGHWAY 110",
            "city": "AURORA",
            "state": "MN",
            "postal_code": "557051522",
            "telephone_number": "218-229-2211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5211 HIGHWAY 110",
            "city": "AURORA",
            "state": "MN",
            "postal_code": "557051522",
            "telephone_number": "218-229-2211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN PINES MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. MARY'S DULUTH CLINIC HEALTH SYSTEM",
        "enumeration_date": "2012-05-21",
        "last_updated": "2013-10-18",
        "status": "A",
        "authorized_official_last_name": "ACKMAN",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "218-229-4222"
    },
    "taxonomies": [
        {
            "code": "261QC0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Critical Access Hospital",
            "state": "MN",
            "license": "00604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881954147",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Northern Pines Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Aurora, MN

Sources for this page

Verify at the official NPI Registry.