St. Luke'S Hospital of Duluth
Organization Active NPI Family Medicine Physician · Hermantown, MN
NPI 1891749594 · NPPES record last updated May 22, 2024
Key facts
- NPI
- 1891749594
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- ST. LUKE'S HOSPITAL OF DULUTH
- Practice address
- 4190 Loberg Ave
Hermantown, MN 55811-2652 - Phone
- (218) 249-5700
- Fax
- (218) 249-4666
- NPI assigned
- May 19, 2006
- Organization subpart
- No
Authorized official
- Name
- Katherine Becker
- Title
- VP Compliance
- Phone
- (218) 249-5555
Owners & managing parties with NPI records 3
Other NPIs on the same Medicare enrollment 32
Related certifications (CCN) 3
Practitioners 29
-
Waldo Avello, M.D.
-
Jordan Blessing, MD
-
Jennifer H Block, MD
-
Brian Anthony Butkus, PA-C
-
Mark W Erhard, MD
-
Roberto Joaquin Fernandez, D.O. MPH
-
Leaola Fields, NP
-
Todd J Freeman, MD
-
David A Hutchinson, M.D.
-
Mikayla Kruschke, MSW, LICSW
-
Joshua M Larson, M.D.
-
Steven E Long, MD
-
Jason D Nelson, CNP
-
Lisa Roazen, M.D.
-
Mark Wiita, APRN, CNP
Affiliated clinicians 657
-
Emily Abernethy, NP
-
Charles Earl Ahrens, M.D.
-
Homam Alkaied, MD
-
Abigail Nancy Anderson, PA-C
-
Kristina Kay Anderson, M.D.
-
Gary Lee Andrews, PA-C
-
Michael James Annen, M.D.
-
Ashley G Aretz I, PA-C
-
Norman Arslanlar, DO
-
David S Arvold, M.D.
-
Nils D Arvold, M.D.
-
Sarah Beth Astorga, M.D.
-
Amanda Baillargeon, M.D.
-
Shawn Celeste Baker, CRNA
-
Rebekah Beach, MD
-
Patrick M. Belson, D.O.
-
Joseph Benert, MD
Medicare Care Compare: Hospital
- Listed as
- St Lukes Hospital
- Overall star rating
- ★★★☆☆ 3 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in MN, WI
Hospital certification: CCN 240047
- Legal name
- ST. LUKE'S HOSPITAL OF DULUTH
- Doing business as
- ASPIRUS ST LUKES HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- Dec 13, 1990
- Beds
- 267
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 915 E 1St St
Duluth, MN 55805-2107 - Hospital subgroups
- General, Acute care
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Scott Allen Lyons |
Corporate Officer |
Oct 1, 2023 | |
| Kiera Marie Wilson |
Corporate Officer |
Oct 1, 2023 | |
| Mitchell Lynn Cardwell |
Corporate Officer |
Oct 1, 2020 | |
| Maurine Helen Settergren |
Corporate Officer |
Oct 1, 2020 | |
| Helena Everett Jackson |
Corporate Officer |
Oct 1, 2023 | |
| Aspirus, Inc |
Operational/Managerial Control | Mar 1, 2024 | 100% |
| Anna Christine Sackette-Urness |
Corporate Officer |
Jun 1, 2022 | |
| James Matheson |
Corporate Officer |
Mar 1, 2024 | |
| Jack Herman Seiler |
Corporate Officer |
Oct 1, 2022 | |
| Nicholas J Van Deelen |
Corporate Director |
Jan 16, 2019 | |
| Aimee Nelson Vanstraaten |
Corporate Director |
Feb 29, 2016 | |
| Lori Peck |
W-2 Managing Employee |
Mar 1, 2024 | |
| Tyler Hack |
W-2 Managing Employee |
Mar 1, 2024 | |
| Matthew F Heywood |
W-2 Managing Employee | Mar 1, 2024 | |
| Yvonne Marie Solon |
Corporate Director |
Apr 27, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031120000212 | MN | Part B Supplier - Clinic/Group Practice | 7113834839 |
Receives reassigned benefits from 584 practitioners This NPI is an additional NPI on the enrollment Practice locations: Grand Rapids, MN; Duluth, MN; Hibbing, MN; Moose Lake, MN; Proctor, MN; Silver Bay, MN; Two Harbors, MN; Virginia, MN… |
| O20040323000234 | WI | Part B Supplier - Clinic/Group Practice | 7113834839 |
Receives reassigned benefits from 88 practitioners 11 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Ashland, WI; Washburn, WI; Superior, WI; South Range, WI; Mellen, WI |
| O20050404000822 | MN | Part a Provider - Hospital | 7113834839 |
25 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
National Provider Directory
Locations
4702 Grand Ave
Duluth, MN 55807
Phone (218) 249-6800
324 W Superior St
Ste 220
Duluth, MN 55802
Phone (218) 249-3500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
4190 Loberg Ave
Hermantown, MN 55811-2652
Mailing address
4190 Loberg Ave
Hermantown, MN 55811-2652
Phone (218) 249-5700
Other names
- Aspirus St Lukes Urgent Care Hermantown
Other providers in Hermantown, MN
- Pheobe R Slayton
- Willow Christine Sloan
- Lindsey Lucille Sobania
- Solace Bay Counseling Associates, LLC
- Seth Sorum
- Kayloni Mary Stanley
- Kyra Lee Stark
- Kallan Stedje
- Kayla Stephenson
- Kristi Marie Stroh
All providers in Hermantown, MN · Family Medicine Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 22, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.