CENTRACARE CLINIC (NPI# 1669994315) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669994315 |
| Entity Type | Organization |
| Organization Name | CENTRACARE CLINIC |
| Other Organization Name | ST CLOUD MEDICAL GROUP - SOUTH |
| Practice Address |
1301 33rd St S Saint Cloud MN 56301-9668 |
| Mailing Address |
1200 6th Ave N Saint Cloud MN 56303-2735 |
| Practice Telephone | 3202518181 |
| Practice Fax Number | 3202571733 |
| Mailing Telephone | 3202525131 |
| Mailing Fax Number | 3202402118 |
| Enumeration Date | 2017-07-14 |
| Last Update Date | 2020-07-15 |
| Authorized Official Name | THOMAS M FELDHEGE (TREASURER/DIRECTOR OF FINANCE) |
| Authorized Official Telephone | 3202402152 |
| Is Organization Subpart | Y |
| Parent Organization Name | CENTRACARE CLINIC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QU0200X |
Clinic/Center Specialization: Urgent Care |
Ambulatory Health Care Facilities | ||
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| St Cloud Medical Group - South | 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 |
1301 33RD ST S |
| City | SAINT CLOUD |
| State | MN |
| Zip Code | 56301-9668 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013912559 | Kristen J Heffern | Nurse Practitioner | 1301 33rd St S, Saint Cloud, MN 56301-9668 | 2005-06-20 |
| 1649885922 | Amal Mohamed Farah | Family Medicine | 1301 33rd St S, Saint Cloud, MN 56301-9668 | 2020-09-13 |
| 1275163388 | Jamie Rae Pohlmann | Physical Therapist | 1301 33rd St S, Saint Cloud, MN 56301-9668 | 2020-01-17 |
| 1679133052 | Stephanie Marie Gagelin | Physician Assistant | 1301 33rd St S, Saint Cloud, MN 56301-9668 | 2019-06-18 |
| 1063935955 | Amanda Marilyn Michalski | Physician Assistant | 1301 33rd St S, Saint Cloud, MN 56301-9668 | 2017-07-21 |
| 1568811529 | Carly Elizabeth Schmitt | Physical Therapist | 1301 33rd St S, Suite 210, Saint Cloud, MN 56301-9668 | 2016-06-09 |
| 1548616576 | Brianna Thour | Physical Therapist | 1301 33rd St S, Suite 210, Saint Cloud, MN 56301-9668 | 2016-05-09 |
| 1427439454 | Noah Helgerson | Physical Therapist | 1301 33rd St S, Suite 210, Saint Cloud, MN 56301-9668 | 2015-06-16 |
| 1205225224 | Jamie Marie Dockendorf | Physician Assistant | 1301 33rd St S, Saint Cloud, MN 56301-9668 | 2015-01-14 |
| 1407121841 | Southside Pharmacy Ltd | Pharmacy | 1301 33rd St S, Saint Cloud, MN 56301-9668 | 2012-03-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013528207 | Stephen Sean Jenkins | Psychologist | 720 Fourth Ave. S., Eastman Hall 305, Saint Cloud, MN 56301 | 2020-08-12 |
| 1316453442 | Amber Grengs | Behavior Technician | 3721 23rd St S Ste 201, Saint Cloud, MN 56301 | 2017-12-27 |
| 1124532999 | Ashley Aune Lewandowski | Chiropractor | 3333 W. Division St. Suite 122a, St. Cloud, MN 56301 | 2017-11-30 |
| 1962923680 | Inspired By You Home Care, LLC | Home Health | 2700 1st Street N, Suite 202, St Cloud, MN 56301 | 2017-07-03 |
| 1487189569 | Brett Finberg | Pharmacy Technician | 141 33rd Ave South, Saint Cloud, MN 56301 | 2017-04-26 |
| 1629513221 | Robert Schug | Pharmacy Technician | 141 33rd Ave S, Saint Cloud, MN 56301 | 2017-01-05 |
| 1649726910 | Rebecca Hoffman Pllc | Specialist | 3400 1st Street N, Suite 300, St. Cloud, MN 56301 | 2016-08-28 |
| 1558728600 | Language Partners | Interpreter | 400 1st St S, Suite 600, St. Cloud, MN 56301 | 2016-01-20 |
| 1679981856 | Quality Homecare Services Inc | Home Health | 3450 W Germain St, Ste 206, St Cloud, MN 56301 | 2014-07-31 |
| 1063759546 | Grand St Paul Cvs, LLC | Durable Medical Equipment & Medical Supplies | 2420 Division St, St. Cloud, MN 56301 | 2013-01-03 |
| Find all providers in zip 56301 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902392525 | Odam Medical Group | Clinic/Center | 3405 3rd St N, Saint Cloud, MN 56303-4015 | 2018-07-06 |
| 1922309582 | Best of Health Medical Clinic,llc | Clinic/Center | 524 13 Th Street, Saint Cloud, FL 34769 | 2010-11-12 |
| 1518268283 | Walk In Medical Clinic and Fitness Center, LLC | Clinic/Center | 3105 Innovation Dr Ste A, Saint Cloud, FL 34769-6501 | 2010-11-10 |
| 1114414380 | Jose A Rivera | Clinic/Center | 3201 Budinger Ave, Saint Cloud, FL 34769-7203 | 2018-04-13 |
| 1730692450 | Carrousel Health Care Corporation | Clinic/Center | 3201 Budinger Ave, Saint Cloud, FL 34769-7203 | 2017-11-16 |
| 1689196339 | Centracare Clinic | Clinic/Center | 251 County Road 120, Saint Cloud, MN 56303-4872 | 2017-07-14 |
| 1538696323 | Centracare Clinic | Clinic/Center | 1200 6th Ave N, Saint Cloud, MN 56303-2735 | 2017-05-11 |
| 1336520105 | Cloud Care LLC | Clinic/Center | 3720 Cord Ave, Saint Cloud, FL 34772-8061 | 2015-06-17 |
| 1881004596 | Z Medical Center LLC | Clinic/Center | 1600 Budinger Ave Ste A, Saint Cloud, FL 34769-6007 | 2014-05-02 |
| 1790124741 | East Lake Medical Clinic | Clinic/Center | 4737 Old Canoe Creek Rd, Saint Cloud, FL 34769-1400 | 2013-06-21 |
| Find all providers in SAINT CLOUD | ||||
| City | SAINT CLOUD |
| Zip Code | 56301 |
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.