ESSENTIA HEALTH ST. JOSEPH'S-PEQUOT LAKES CLINIC
NPI 1730134891
Clinic/Center - Primary Care in Pequot Lakes, MN
About Essentia Health St. Joseph's-pequot Lakes Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ESSENTIA HEALTH ST. JOSEPH'S-PEQUOT LAKES CLINIC (NPI 1730134891) is a healthcare organization registered as a primary care in Pequot Lakes, Minnesota and active in the NPI registry since May 2006. The organization holds a CLIA Waiver certificate valid through September 7, 2027 and lists Kevin Boren, Vp Of Finance, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Other Identifiers 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Essentia Health St. Joseph's-pequot Lakes Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by December 31, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
340Medicare enrollment records show 340 clinicians reassign Medicare billing to Essentia Health St. Joseph's-Pequot Lakes Clinic, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 5 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 37
Nearest to this location (20)
See all 340Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 24D0682150
Essentia Health St Josephs - Pequot Lakes Clinic · Pequot Lakes, MNFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is St. Joseph's Medical Center's NPI number?
The NPI number for St. Joseph's Medical Center is 1730134891. It was assigned to this organization in the NPPES registry on May 24, 2006. The provider is doing business as Essentia Health St. Joseph's-Pequot Lakes Clinic.
Where is St. Joseph's Medical Center located?
St. Joseph's Medical Center is located at 4317 W Woodman St, Pequot Lakes, MN 56472. The listed phone number is (218) 568-4416.
What is St. Joseph's Medical Center's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is St. Joseph's Medical Center enrolled in Medicare?
Yes. St. Joseph's Medical Center is registered in the Medicare PECOS enrollment system.
When is St. Joseph's Medical Center's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Minnesota, Clinic/Group Practice) is due for revalidation by December 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through St. Joseph's Medical Center?
According to the CMS Revalidation Reassignment List (October 2026 release), 340 clinicians in 37 Medicare specialties reassign their Medicare billing to St. Joseph's Medical Center. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (74), Emergency Medicine (29) and Certified Registered Nurse Anesthetist (CRNA) (27). Of these, 2 practice at this address and 5 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does St. Joseph's Medical Center hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 24D0682150) is associated with this NPI, valid through September 7, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does St. Joseph's Medical Center accept?
Health plans from Sanford Health Plan list St. Joseph's Medical Center as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for St. Joseph's Medical Center was last updated on February 27, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Essentia Health St. Joseph's-Pequot Lakes Clinic · NPI 1730134891
Primary Care organization in Pequot Lakes, Minnesota. Organization record, active in the CMS NPPES registry since May 24, 2006.
## Identity
- **NPI:** 1730134891 (Entity type: Organization)
- **Enumerated:** May 24, 2006
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Legal business name:** St. Joseph's Medical Center
- **Organization subpart:** Yes (part of Essentia Health)
- **Authorized official:** Kevin Boren, VP OF FINANCE
## Practice location
- **Address:** 4317 W WOODMAN ST, Pequot Lakes, MN 56472-3473
- **Phone:** (218) 568-4416 · **Fax:** (218) 568-4625
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** December 31, 2026 (Non-DME Part B, Minnesota, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 340 clinicians in 37 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (74), Emergency Medicine (29), Certified Registered Nurse Anesthetist (CRNA) (27); 2 practice at this address and 5 within 10 miles; [full list](https://npiprofile.com/npi/1730134891/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** February 27, 2024
- **Other identifiers:** Medicaid 595013900 (MN)
- **CLIA laboratory certificates:** 1 on file
---
Source: [NPI Profile](https://npiprofile.com/npi/1730134891) · Data from the CMS NPPES public registry.