CENTRACARE CLINIC (NPI# 1164978219) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164978219 |
| Entity Type | Organization |
| Organization Name | CENTRACARE CLINIC |
| Other Organization Name | MIDSOTA PLASTIC & RECONSTRUCTIVE SURGEONS |
| Practice Address |
3701 12th St N Suite 100 Saint Cloud MN 56303-2255 |
| Mailing Address |
1200 6th Ave N Saint Cloud MN 56303-2735 |
| Practice Telephone | 3202537257 |
| Practice Fax Number | 3202575671 |
| Mailing Telephone | 3202525131 |
| Mailing Fax Number | 3202402118 |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2016-08-29 |
| Authorized Official Name | THOMAS M FELDHEGE (TREASURER) |
| Authorized Official Telephone | 3202402152 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | MN | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | MEDICAID | 990228700 | 01 |
| MN | HEALTH PARTNERS | 35580 | 01 |
| MN | UCARE | 110890 | 01 |
| MN | MEDICA | 98-04122 | 01 |
| MN | BLUE CROSS BLUE SHIELD | 6D053CE | 01 |
| MN | CHAMPUS | N002912 | 01 |
| Other Name | Type Code |
|---|---|
| Midsota Plastic & Reconstructive Surgeons | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003339789 | Centracare Clinic | Clinic/Center | 2025 Stearns Way Ste 114, Saint Cloud, MN 56303 | 2017-07-25 |
| 1720500309 | Centracare Clinic | Clinic/Center | 2749 Sexton Drive, Mary Hall - Room 001, Collegeville, MN 56321 | 2017-07-14 |
| 1881116747 | Centracare Clinic | Clinic/Center | 402 Red River Ave N Ste 2, Cold Spring, MN 56320-1523 | 2017-07-12 |
| 1558898387 | Centracare Clinic | Clinic/Center | 161 Glen St., Ste 101, Foley, MN 56329 | 2017-05-11 |
| 1164958104 | Centracare Clinic | Clinic/Center | 113 Waite Ave S Ste 101, Waite Park, MN 56387-1348 | 2017-05-11 |
| 1770020489 | Centracare Clinic | Clinic/Center | 2001 Stockinger Drive, Suite 101, St Cloud, MN 56303 | 2017-01-20 |
| 1679025746 | Centracare Clinic | Clinic/Center | 7418 Forthun Rd, Baxter, MN 56425-8702 | 2016-10-25 |
| 1962958611 | Centracare Clinic | Exclusive Provider Organization | 166 19th Street S, Suite 202, Sartell, MN 56377 | 2016-08-31 |
| 1700281953 | Centracare Clinic | Urology | 2351 Connecticut Ave S, Suite 200, Centracare Clinic- Adult & Pediatric Urology, Sartell, MN 56377-2477 | 2014-10-30 |
| 1043212665 | Centracare Clinic | Clinic/Center | 1200 Sixth Ave No, Centracare Clinic, St Cloud, MN 56303-2735 | 2005-08-12 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | CENTRACARE CLINIC RIVER CAMPUS | 1200 6th Ave N, Saint Cloud, MN 56303-2735 |
| Street Address |
3701 12TH ST N SUITE 100 |
| City | SAINT CLOUD |
| State | MN |
| Zip Code | 56303-2255 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285684415 | Jay Lenard Horowitz | Anesthesiology | 3701 12th St N, Suite 202, Saint Cloud, MN 56303-2255 | 2006-05-10 |
| 1497292783 | Carolyn Juske | Counselor | 3701 12th St N, Suite 203, Saint Cloud, MN 56303-2255 | 2017-01-24 |
| 1265976518 | Mark Raykowski | Nurse Anesthetist, Certified Registered | 3701 12th St N, Suite 202, Saint Cloud, MN 56303-2255 | 2016-12-06 |
| 1598208308 | Andrew Mackey | Counselor | 3701 12th St N, Suite 203, Saint Cloud, MN 56303-2255 | 2016-11-28 |
| 1124574199 | Ana Morse | Counselor | 3701 12th St N, Suite 203, Saint Cloud, MN 56303-2255 | 2016-08-30 |
| 1194271239 | Centracare Surgery Center | Clinic/Center | 3701 12th St N, 101, Saint Cloud, MN 56303-2255 | 2016-08-29 |
| 1194279448 | Cari Binsfeld | Marriage & Family Therapist | 3701 12th St N, Suite 203, Saint Cloud, MN 56303-2255 | 2016-08-03 |
| 1003360355 | Clint Sauer | Marriage & Family Therapist | 3701 12th St N, Suite 203, Saint Cloud, MN 56303-2255 | 2016-08-03 |
| 1740633106 | Thomas Tate | Nurse Anesthetist, Certified Registered | 3701 12th St N, Suite 202, Saint Cloud, MN 56303-2255 | 2016-07-20 |
| 1003264441 | Craig Tangen | Nurse Anesthetist, Certified Registered | 3701 12th St N, Suite 202, Saint Cloud, MN 56303-2255 | 2016-05-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841800463 | Daniel P Lahr | Radiologic Technologist | St Cloud Va Health Care System, 4801 Veterans Drive, St Cloud, MN 56303 | 2020-08-07 |
| 1730798398 | County of Stearns | Case Management | 705 Courthouse Square, St Cloud, MN 56303 | 2020-07-29 |
| 1669007126 | Aflah Transportation LLC | Non-emergency Medical Transport (VAN) | 3316 3rd Street North, Suite 129, Saint Cloud, MN 56303 | 2020-03-05 |
| 1609420942 | Stephanie Lynne Metzger | Nurse Practitioner | Centracare Clinic Riverc Ampus/nephrology, 1200 Sixth Ave North, St. Cloud, MN 56303 | 2019-07-25 |
| 1306406947 | Willow Tree Acupuncture LLC | Acupuncturist | 203 Cooper Ave N Suite 160, St. Cloud, MN 56303 | 2019-06-17 |
| 1821553520 | Alan Melvin Hoeper | Nurse Anesthetist, Certified Registered | Centracare Clinic Anesthesiology, 3701 12th St N, Suite 202, St. Cloud, MN 56303 | 2019-02-06 |
| 1437644465 | Brianna Larissa Justin | Speech-Language Pathologist | St. Cloud Hospital, 1406 6th Avenue N, St. Cloud, MN 56303 | 2018-06-22 |
| 1780186486 | Simplicity Health Pa | Family Medicine | 1511 Northway Dr Ste 103, Saint Cloud, MN 56303 | 2018-03-08 |
| 1639682925 | Dereje Beyene | Respiratory Therapist, Certified | 1406 15th Street North, Saint Cloud, MN 56303 | 2017-11-09 |
| 1740792761 | Lisa Ann Horner | Nurse Practitioner | 1555 Northway Drive #110, Centracare Complex Care Clinic, St Cloud, MN 56303 | 2017-10-31 |
| Find all providers in zip 56303 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780295618 | Unutrition LLC | Clinic/Center | 500 Moonlight Ct, Saint Cloud, FL 34771-9062 | 2020-08-13 |
| 1770115537 | Therapy World LLC | Clinic/Center | 4111 Neptune Rd, Saint Cloud, FL 34769-6741 | 2020-02-10 |
| 1285198663 | Center for Life Transitions | Clinic/Center | 38 24th Ave N, Saint Cloud, MN 56303-4340 | 2019-01-30 |
| 1720561087 | Ideal Option, Pllc | Clinic/Center | 451 E Saint Germain St Ste 200, Saint Cloud, MN 56304-0759 | 2018-09-12 |
| 1083164255 | Centracare Health System | Clinic/Center | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2016-10-11 |
| 1821471962 | Breath of Life Diagnostics | Clinic/Center | 3505 Progress Ln, Saint Cloud, FL 34769-6519 | 2015-07-07 |
| 1669807897 | Centracare Health System | Clinic/Center | 1900 Centracare Cir, Saint Cloud, MN 56303-5000 | 2013-09-06 |
| 1275818858 | Abdul B Lodhi Md Pa | Clinic/Center | 1600 Budinger Ave Ste A, Saint Cloud, FL 34769-6007 | 2011-10-14 |
| 1982937827 | Keith Larson Neurology Pllc | Clinic/Center | 1511 Northway Dr, Suite 202, Saint Cloud, MN 56303-1261 | 2009-09-10 |
| 1679708887 | Iris Vision Care, LLC. | Clinic/Center | 1301 33rd St S, Suite 104, Saint Cloud, MN 56301-9668 | 2009-05-18 |
| Find all providers in SAINT CLOUD | ||||
| City | SAINT CLOUD |
| Zip Code | 56303 |
Please comment or provide details below to improve the information on CENTRACARE CLINIC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.