ST MARY'S REGIONAL HEALTH CENTER (NPI# 1639513377) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639513377 |
| Entity Type | Organization |
| Organization Name | ST MARY'S REGIONAL HEALTH CENTER |
| Other Organization Name | ESSENTIA HEALTH ST. MARY'S - DETROIT LAKES CLINIC |
| Practice Address |
1027 Washington Ave Detroit Lakes MN 56501-3409 |
| Practice Telephone | 2188442300 |
| Mailing Telephone | 2188442300 |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2019-05-17 |
| Authorized Official Name | RYAN L HILL (CFO) |
| Authorized Official Telephone | 2188475611 |
| Is Organization Subpart | Y |
| Parent Organization Name | ST. MARY'S REGIONAL HEALTH CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 892442000 | 05 |
| Other Name | Type Code |
|---|---|
| Essentia Health St. Mary's - Detroit Lakes Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902364482 | St Mary's Regional Health Center | Clinic/Center | 300 E Main Ave, Frazee, MN 56544-4504 | 2019-03-04 |
| 1437290335 | St Mary's Regional Health Center | Assisted Living Facility | 208 Oak Street, Detroit Lakes, MN 56501 | 2007-02-12 |
| 1669998571 | St Mary's Regional Health Center | Occupational Therapist | 705 Pleasant Ave S, Park Rapids, MN 56470-1440 | 2017-08-22 |
| 1710403639 | St Mary's Regional Health Center | Speech-Language Pathologist | 212 Aspen Ave Ne, Menahga, MN 56464-3289 | 2017-08-22 |
| 1467798322 | St Mary's Regional Health Center | Family Medicine | 212 Aspen Ave Ne, Menahga, MN 56464-3289 | 2012-12-21 |
| 1558607408 | St Mary's Regional Health Center | Family Medicine | 110 Michigan Ave W, Walker, MN 56484-2274 | 2012-12-21 |
| 1699955344 | St Mary's Regional Health Center | Family Medicine | 705 Pleasant Ave S, Park Rapids, MN 56470-1440 | 2007-11-10 |
| 1467640797 | St Mary's Regional Health Center | Durable Medical Equipment & Medical Supplies | 1027 Washington Ave, Detroit Lakes, MN 56501-3409 | 2007-10-11 |
| 1952484404 | St Mary's Regional Health Center | Hospice Care, Community Based | 900 Hilligoss Blvd Se, Fosston, MN 56542-1542 | 2006-10-20 |
| 1518929934 | St Mary's Regional Health Center | Home Health | 115 W 2nd St, Graceville, MN 56240 | 2006-04-03 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | ST MARY'S REGIONAL HEALTH CENTER | 1027 Washington Ave, Detroit Lakes, MN 56501-3409 |
| Street Address |
1027 WASHINGTON AVE |
| City | DETROIT LAKES |
| State | MN |
| Zip Code | 56501-3409 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063414084 | Janell Kjos | Nurse Practitioner | 1027 Washington Ave, Detroit Lakes, MN 56501-3409 | 2005-08-10 |
| 1962003277 | Mary C Wiczek | Nurse Practitioner | 1027 Washington Ave, Detroit Lakes, MN 56501-3409 | 2020-11-03 |
| 1760096481 | Nikki Lynn Oliver | Nurse Practitioner | 1027 Washington Ave, Detroit Lakes, MN 56501-3409 | 2020-09-01 |
| 1215548680 | Sherri L Softing | Dietitian, Registered | 1027 Washington Ave, Detroit Lakes, MN 56501-3409 | 2020-08-11 |
| 1841817384 | Rachel D Karlson | Nurse Practitioner | 1027 Washington Ave, Detroit Lakes, MN 56501-3409 | 2020-07-01 |
| 1063037489 | Caitlin Ann Kumpula | Registered Nurse | 1027 Washington Ave, Detroit Lakes, MN 56501-3409 | 2020-06-11 |
| 1225662695 | Rebecca D Peterson | Hospitalist | 1027 Washington Ave, Detroit Lakes, MN 56501-3409 | 2020-02-25 |
| 1548893183 | Katherine A Starbeck | Nurse Practitioner | 1027 Washington Ave, Detroit Lakes, MN 56501-3409 | 2020-02-21 |
| 1548819519 | Taylor Jones Thooft | Pharmacist | 1027 Washington Ave, Detroit Lakes, MN 56501-3409 | 2019-09-11 |
| 1437717618 | Connor J Camrud | Physical Therapist | 1027 Washington Ave, Detroit Lakes, MN 56501-3409 | 2019-06-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588265649 | Candace Louise Haugtvedt | Pharmacist | 321 Us-10 West, Detroit Lakes, MN 56501 | 2020-11-05 |
| 1679068407 | Strive Chiropractic Detroit Lakes LLC | Chiropractor | 1852 Nodaway Drive, Detroit Lakes, MN 56501 | 2018-06-25 |
| 1194215830 | Jordan James Reese | Registered Nurse | 1295 Bay Ridge Dr, Detroit Lakes, MN 56501 | 2018-05-17 |
| 1992179386 | Compassion House | Substance Abuse Rehabilitation Facility | 811 8th St. Se, Detroit Lakes, MN 56501 | 2015-11-23 |
| 1720344286 | Lakes Crisis & Resource Center | Clinic/Center | 1339 Pelican Lane, Detroit Lakes, MN 56501 | 2012-04-09 |
| 1063657120 | Diane Jean Mccormack | Occupational Therapist | 15840 Long Lake Road, Detroit Lakes, MN 56501 | 2008-12-03 |
| 1588817928 | Darcy Caleb Olson | Counselor | 925 Lake Ave, Detroit Lakes, MN 56501 | 2008-10-29 |
| 1760651079 | Rapidcare Urgent Care Pllc | Family Medicine | 1361 Wenner Road, Detroit Lakes, MN 56501 | 2008-02-21 |
| 1427274729 | Jeffrey C Gregory | Psychologist | 910 Lincoln Ave, Detroit Lakes, MN 56501 | 2007-04-17 |
| 1144364894 | Midwest Vision Centers Inc | Eyewear Supplier (Equipment, not the service) | 830 Washington Avenue, Detroit Lakes, MN 56501 | 2007-02-16 |
| Find all providers in zip 56501 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760651079 | Rapidcare Urgent Care Pllc | Family Medicine | 1361 Wenner Road, Detroit Lakes, MN 56501 | 2008-02-21 |
| 1639270069 | Kevin R Wentworth | Family Medicine | 1027 Washington Avenue, Detroit Lakes, MN 56501-3409 | 2006-09-26 |
| 1104877455 | Dakota Clinic, Ltd. | Family Medicine | 125 Frazee St E, Detroit Lakes, MN 56501-3501 | 2006-05-12 |
| 1871582643 | Mark David Lindquist | Family Medicine | 1245 Washington Ave, Detroit Lakes, MN 56501 | 2005-10-14 |
| 1295268993 | Tricia Rae Brein | Family Medicine | 1027 Washington Ave, Detroit Lakes, MN 56501-3409 | 2017-04-10 |
| 1164978599 | Innovis Health LLC | Family Medicine | 1361 Wenner Rd, Detroit Lakes, MN 56501-7918 | 2016-08-26 |
| 1538513155 | Molly Marie Anderson | Family Medicine | 1245 Washington Ave, Detroit Lakes, MN 56501-3905 | 2016-04-20 |
| 1376823674 | Sanford Medical Center Fargo | Family Medicine | 1245 Washington Ave, Detroit Lakes, MN 56501-3905 | 2011-08-18 |
| 1043519796 | Gaurav Suresh Mehta | Family Medicine | 1027 Washington Avenue, Detroit Lakes, MN 56501-3409 | 2011-03-21 |
| 1235450982 | Charles Stephen Shaffer | Family Medicine | 1027 Washington Ave, Detroit Lakes, MN 56501 | 2010-06-17 |
| Find all providers in DETROIT LAKES | ||||
| City | DETROIT LAKES |
| Zip Code | 56501 |
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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.