NPIMap

Organization Active NPI

Northern Pines Medical Center

Doing business as Essentia Health Northern Pines

  • Medicare Defined Swing Bed Hospital Unit
  • Aurora, MN
National Provider Identifier
1902243280
Registry record updated Feb 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
361346 Issued in MN
Legal business name
NORTHERN PINES MEDICAL CENTER
Doing business as
Essentia Health Northern Pines
Essentia Health Northern Pines (Swingbed)
Practice address
5211 Highway 110
Aurora, MN 55705-1522
Phone
(218) 229-2211
Fax
(218) 229-2042
NPI assigned
May 28, 2013
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
Kevin Boren
Title
VP of Finance
Phone
(218) 786-1009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 361346 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
1902243280MedicaidMN

Other names 2

  • Essentia Health Northern Pines Doing business as
  • Essentia Health Northern Pines (Swingbed) Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090603000064 MN Part A Provider - Critical Access Hospital 3870565641 1 other NPI on this enrollment
Practice locations: Aurora, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902243280. Details of each certification follow.

Hospital certification: CCN 24Z340

Legal name
NORTHERN PINES MEDICAL CENTER
Doing business as
ESSENTIA HEALTH NORTHERN PINES
Organization structure
CorporationNon-profit
Incorporated
Sep 8, 2010 in MN
Enrollment address
5211 Highway 110
Aurora, MN 55705-1522

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).

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
Tax ID family
Northern Pines Medical Ctr4 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.

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.

Facilities with the same owner 46

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

View all 46

Practitioners & affiliated clinicians

Affiliated clinicians 8

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": "1369699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708992000000",
    "number": "1902243280",
    "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",
            "fax_number": "218-229-2042"
        },
        {
            "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",
            "fax_number": "218-229-2042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN PINES MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESSENTIA HEALTH",
        "enumeration_date": "2013-05-28",
        "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": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "MN",
            "license": "361346",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1902243280",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Northern Pines",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Essentia Health Northern Pines",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Essentia Health Northern Pines (Swingbed)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Aurora, MN

Sources for this page

Verify at the official NPI Registry.