NORTHERN LAKES SURGERY CENTER LLC
NPI 1649922485
Clinic/Center - Ambulatory Surgical in Moose Lake, MN
NPI Status: Active since January 24, 2022
Contact Information
4791 COUNTY ROAD 10
MOOSE LAKE, MN
ZIP 55767
Phone: (218) 249-5357
- Organization
- Clinic/Center
- Ambulatory Surgical
- Accepts Insurance
- CLIA Number: 24D2264643
- CLIA Cert. Type: Ambulatory Surgery Center
- CLIA Exp. Date: 07-17-2026
About NORTHERN LAKES SURGERY CENTER LLC
This page provides the complete NPI Profile along with additional information for Northern Lakes Surgery Center Llc, a provider established in Moose Lake, Minnesota operating as a Clinic/center, focusing in ambulatory surgical . The healthcare provider is registered in the NPI registry with number 1649922485 assigned on January 2022. The practitioner's primary taxonomy code is 261QA1903X. The provider is registered as an organization and their NPI record was last updated March 2026. The authorized official of this NPI record is Lori Peck (Svp- Chief Financial Officer)
- NPI
- 1649922485
- Provider Name
- NORTHERN LAKES SURGERY CENTER LLC
- Entity Type
- Organization
- Location Address
- 4791 COUNTY ROAD 10 MOOSE LAKE, MN 55767
- Location Phone
- (218) 249-5357
- Mailing Address
- 915 E 1ST ST DULUTH, MN 55805
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 01-24-2022
- Last Update Date
- 03-11-2026
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Ambulatory Surgical
- Taxonomy Code
- 261QA1903X
- Type
- Ambulatory Health Care Facilities
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Atlas $1,300 Gold - PPO
- Atlas $2,000 Standard Gold - PPO
- Atlas $3,050 Plus Silver - PPO
- Atlas $3,800 HSA Silver - PPO
- Atlas $6,000 Standard Silver - PPO
- Atlas $6,800 Plus Bronze HSA - PPO
- Atlas $7,500 Standard Bronze HSA - PPO
- Atlas $8,400 HSA Bronze - PPO
- Premier $2,000 - 25% - HMO
- Premier $3,500 - 30% - HMO
- Premier $4,000 - 50% - HMO
- Premier $5,000 HDHP - HMO
- Premier $6,000 - 40% - HMO
- Premier $7,500 - HMO
- Premier $7,500 HDHP - HMO
- Premier HMO $1,500 - 30% - HMO
- Premier HMO $2,500 - 20% Copay - HMO
- Premier HMO $3,400 - 30% HDHP - HMO
- Premier HMO $3,500 - 30% - HMO
- Premier HMO $3,500 HDHP - HMO
- Premier HMO $4,000 - 20% HDHP - HMO
- Premier HMO $5,000 - 20% HDHP - HMO
- Premier HMO $5,500 - 40% Copay - HMO
- Premier HMO $7,500 HDHP - HMO
- Premier HMO $750 - 10% - HMO
- Premier HMO $9,500 - HMO
- Premier POS $1,500 - 30% - POS
- Premier POS $2,500 - 20% Copay - POS
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Areas of Expertise
The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.
Biopsy of large bowel using a flexible endoscope
Removal of polyps or growths of large bowel using an endoscope with mechanical snare
A biopsy of the large bowel using a flexible endoscope is a procedure where a thin, flexible tube with a camera is inserted through the rectum to examine the bowel. If abnormal tissue is found, a small sample is taken for further examination. This helps in diagnosing conditions like inflammation, polyps, or cancer.
This service was performed 18 times for 18 patientsThis procedure involves using a thin, flexible tube called an endoscope to examine the large bowel. If any abnormal growths or polyps are found, a tool called a mechanical snare is used to remove them. This is a common method to prevent potential health issues.
This service was performed 11 times for 11 patientsCLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 24D2264643
- Facility Type
- Ambulatory Surgery Center
- Certificate Effective Date
- July 18, 2024
- Certificate Expiration Date
- July 17, 2026
- Laboratory Director
- JACQUELINE VOLK
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Northern Lakes Surgery Center Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1649922485, we treat the final digit (5) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 75. The final step is to find the difference between that total and the next multiple of ten (80 - 75 = 5).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 75 is 80. The difference is the calculated check digit.
Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1649922485, enumerated as an "organization" on January 24, 2022.
The provider is located at 4791 COUNTY ROAD 10 MOOSE LAKE, MN 55767 and the phone number is (218) 249-5357.
Clinic/Center with taxonomy code 261QA1903X and a focus in Ambulatory Surgical.
The provider might be accepting Accepts: HealthPartners and Security Health Plan. Please consult your insurance carrier or call the provider to verify.
