NPIMap

Organization Active NPI

St. Joseph'S Medical Center

  • Primary Care Clinic/Center
  • Pillager, MN
National Provider Identifier
1891740957
Registry record updated Feb 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
330736 Issued in MN
Legal business name
ST. JOSEPH'S MEDICAL CENTER
Practice address
680 Pillsbury St N
Pillager, MN 56473
Phone
(218) 746-4527
Fax
(218) 746-4528
NPI assigned
May 24, 2006
Organization subpart
Yes
Parent organization
ESSENTIA HEALTHAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Kevin Boren
Title
VP of Finance
Phone
(218) 786-1009

Owners & managing parties with NPI records 5

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

Other NPIs on the same Medicare enrollment 14

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

View all 14

Practitioners 70

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 70

Affiliated clinicians 342

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

View all 342

Care Compare: Hospital

Medicare Care Compare
Listed as
Essentia Health St Joseph'S Medical CenterCCN 240075
Overall star rating
3 of 5
Type
Acute Care 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
24D1017506Essentia Health St Josephs - Pillager Clinic680 Pillsbury St N, Pillager, MN 56473Certificate of waiverSep 30, 2027

Medicare participation

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

Hospital certification: CCN 240075

Legal name
ST JOSEPHS MEDICAL CENTER
Doing business as
ESSENTIA HEALTH - ST JOSEPHS MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Oct 1, 2015
Beds
162
Ownership / control type
Private (not for profit)
Most recent change of ownership
Oct 1, 1985 (2 total)
Organization structure
CorporationNon-profit
Enrollment address
523 N 3Rd St
Brainerd, MN 56401-3054
Main/Primary Hospital Location
Hospital subgroups
Acute care

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030702000029 MN Part A Provider - Hospital 8224948443 10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pierz, MN; Pillager, MN; Brainerd, MN; Pequot Lakes, MN; Crosslake, MN; Staples, MN; Pine River, MN; Deerwood, MN…
O20031119000468 MN Part B Supplier - Clinic/Group Practice 8224948443 Receives reassigned benefits from 361 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pequot Lakes, MN; Pierz, MN; Pillager, MN; Pine River, MN; Plymouth, MN; Saint Paul, MN; Crosslake, MN; Shoreview, MN…

All disclosed owners & managing parties 20

Medicare enrollment files

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
Mark Bortnem Individual Corporate OfficerTreasurer Sep 25, 2025
Amy Bergstrom Individual Corporate DirectorBoard Member Jan 1, 2024
Anthony Sertich Individual Corporate DirectorBoard Member Jan 1, 2021
George Loban Individual Corporate DirectorBoard Member Jan 1, 2024
Adam Bachand Individual Corporate DirectorBoard Member Jan 1, 2025
Thomas Jamar Individual Corporate DirectorBoard Member Jan 1, 2023
Rebecca Urbanski Individual Corporate DirectorBoard 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%
Beverly Raway Individual Corporate DirectorBoard Member Jan 1, 2017
St Marys Duluth Clinic Health System Organization, Duluth, MN Non-profit Operational/Managerial Control Jul 1, 2023
Bradley J Beard Individual Corporate OfficerChief Operating Officer Jul 1, 2023
W-2 Managing EmployeeChief Operating Officer Jul 1, 2023
Jeanne Weber Individual Corporate DirectorBoard Member Feb 15, 2019
Sandra Zutz-Wiczek Individual W-2 Managing EmployeeAd; May 6, 2024
Kevin S Boren Individual Corporate OfficerVP of Finance Jan 3, 2022
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
Jan Linse Baldwin Individual Corporate Director Jan 1, 2017
Nancy Aronson Norr Individual Corporate DirectorBoard Member Jan 1, 2025

National Provider Directory

National Provider Directory

Locations

680 Pillsbury St N
#C63360
Pillager, MN 56473
Phone (218) 746-4527

680 Pillsbury St N
Pillager, MN 56473
Phone (218) 746-4527

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 330736 MN Primary

Addresses

NPPES NPI Registry

Primary practice location

680 Pillsbury St N
Pillager, MN 56473

Mailing address

680 Pillsbury St N
Pillager, MN 56473
Phone (218) 746-4527

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
589119100MedicaidMN

Other names 1

NPPES NPI Registry
  • Essentia Health St. Joseph's-Pillager Clinic Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 27, 2024.

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708992000000",
    "number": "1891740957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 PILLSBURY ST N",
            "city": "PILLAGER",
            "state": "MN",
            "postal_code": "56473",
            "telephone_number": "218-746-4527",
            "fax_number": "218-746-4528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 PILLSBURY ST N",
            "city": "PILLAGER",
            "state": "MN",
            "postal_code": "56473",
            "telephone_number": "218-746-4527",
            "fax_number": "218-746-4528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOSEPH'S MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESSENTIA HEALTH",
        "enumeration_date": "2006-05-24",
        "last_updated": "2024-02-27",
        "certification_date": "2024-02-27",
        "status": "A",
        "authorized_official_last_name": "BOREN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "218-786-1009"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MN",
            "license": "330736",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "589119100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health St. Joseph's-Pillager Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Essentia Health St. Joseph's-Pillager Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pillager, MN

Sources for this page

Verify at the official NPI Registry.