CENTRACARE HEALTH SYSTEM (NPI# 1457901506) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457901506 |
| Entity Type | Organization |
| Organization Name | CENTRACARE HEALTH SYSTEM |
| Practice Address |
121 Lake St N Big Lake MN 55309-9254 |
| Mailing Address |
1406 6th Ave N Saint Cloud MN 56303-1900 |
| Practice Telephone | 3202512700 |
| Mailing Telephone | 3202512700 |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2019-09-19 |
| Authorized Official Name | MICHAEL BLAIR (CFO) |
| Authorized Official Telephone | 3202512700 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| CentraCare Emergency Medical Services | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083164255 | Centracare Health System | Clinic/Center | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2016-10-11 |
| 1669807897 | Centracare Health System | Clinic/Center | 1900 Centracare Cir, Saint Cloud, MN 56303-5000 | 2013-09-06 |
| 1215118989 | Centracare Health System | Home Health | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2007-11-21 |
| 1598713075 | Centracare Health System | Clinical Medical Laboratory | 1900 Centracare Cir, Centracare Health Plaza, Saint Cloud, MN 56303-5000 | 2006-05-05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | CENTRACARE HEALTH SYSTEM | 1406 6th Ave N, Saint Cloud, MN 56303-1900 |
| System for Award Management (SAM) Entities | CENTRACARE HEALTH SYSTEM-SAUK CENTRE | 425 Elm St N, Sauk Centre, MN 56378-1010 |
| Street Address |
121 LAKE ST N |
| City | BIG LAKE |
| State | MN |
| Zip Code | 55309-9254 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356986475 | Barbro E Strom Langley | Technician | 16901 River View Cir, Big Lake, MN 55309 | 2019-11-13 |
| 1629589544 | Pdg, Pa | Clinic/Center | 16991 198th Ave Nw, Big Lake, MN 55309 | 2017-10-18 |
| 1669821765 | Laura Ann Dill | Dentist | 290 Eagle Lake Rd N, Big Lake, MN 55309 | 2016-06-09 |
| 1295008068 | Cherrywood Advanced Living, LLC | Assisted Living Facility | 171 Henry Road, Big Lake, MN 55309 | 2012-02-09 |
| 1013280882 | Cherrywood Advanced Living, LLC | Assisted Living Facility | 177 Henry Road, Big Lake, MN 55309 | 2012-02-09 |
| 1760704712 | Mary Ellen Venzke | Adult Companion | 19729 183rd Avenue, Big Lake, MN 55309 | 2010-02-18 |
| 1174700611 | Country Services Inc | Case Management | 641 Park Ave E, Big Lake, MN 55309 | 2008-01-28 |
| 1942481593 | Monticello Dental Group | Dentist | 20460 Co. Rd.11 Nw, Big Lake, MN 55309 | 2007-11-23 |
| 1336367242 | Family Prospective Resources, Inc | Marriage & Family Therapist | 35 Lake St So, Big Lake, MN 55309 | 2007-04-23 |
| 1598983470 | Jennifer Ann Lawrence | Marriage & Family Therapist | 35 Lake Street South #200, Big Lake, MN 55309 | 2007-04-23 |
| Find all providers in zip 55309 | ||||
| Taxonomy Code | 207PE0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| Specialization | Emergency Medical Services |
| An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700082781 | Jeffrey A Lee | Emergency Medicine | 111 Riverfront Ste 208, Winona, MN 55987-3456 | 2007-06-26 |
| 1669544623 | Thomas Charles Koehnen | Emergency Medicine | 38818 730th Ave, Saint James, MN 56081-4482 | 2006-11-14 |
| 1952385304 | Tracy Alan Powell | Emergency Medicine | 303 Catlin St, Buffalo, MN 55313-1947 | 2005-11-30 |
| 1831548676 | Sarah Mott | Emergency Medicine | 1575 Beam Ave, Maplewood, MN 55109-1126 | 2016-06-10 |
| 1508129198 | Amy M. O'neil | Emergency Medicine | 200 1st St Sw, Rochester, MN 55905-0001 | 2012-06-19 |
| 1285994517 | Micah Richard Treuer | Emergency Medicine | 1300 Anne St Nw, Bemidji, MN 56601-5103 | 2012-05-21 |
| 1528324472 | Erin Austad | Emergency Medicine | 333 Smith Ave N, Saint Paul, MN 55102-2344 | 2012-04-04 |
| 1740457902 | Ram Prasad Paneru | Emergency Medicine | 123 4th St Nw, Bagley, MN 56621-8306 | 2008-05-15 |
| 1417123688 | Samuel Robert Goblirsch | Emergency Medicine | 701 Dellwood St S, Cambridge, MN 55008-1920 | 2008-05-07 |
| 1740467760 | Daniel P Dewey | Emergency Medicine | 500 S Maple St, Waconia, MN 55387-1752 | 2008-01-22 |
| Find all providers with the same taxonomy | ||||
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| 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.