CENTRACARE CLINIC (NPI# 1689196339) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689196339 |
| Entity Type | Organization |
| Organization Name | CENTRACARE CLINIC |
| Other Organization Name | ST CLOUD MEDICAL GROUP - NORTHWEST |
| Practice Address |
251 County Road 120 Saint Cloud MN 56303-4872 |
| Mailing Address |
1200 6th Ave N Saint Cloud MN 56303-2735 |
| Practice Telephone | 3202028949 |
| Practice Fax Number | 3202571733 |
| Mailing Telephone | 3202525131 |
| Mailing Fax Number | 3202402118 |
| Enumeration Date | 2017-07-14 |
| Last Update Date | 2017-07-14 |
| 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 |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
MN | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| St Cloud Medical Group - Northwest | 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 |
251 COUNTY ROAD 120 |
| City | SAINT CLOUD |
| State | MN |
| Zip Code | 56303-4872 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285630145 | Traese Yolanda Kuhl | Family Medicine | 251 County Road 120, Saint Cloud, MN 56303-4872 | 2005-06-24 |
| 1205435773 | Cassandra Lee Ackerman | Nurse Practitioner | 251 County Road 120, Saint Cloud, MN 56303-4872 | 2020-10-25 |
| 1164040804 | Jaren Steven Lukach | Nurse Practitioner | 251 County Road 120, Saint Cloud, MN 56303-4872 | 2020-07-09 |
| 1164055505 | Anne Elizabeth Cullen | Physician Assistant | 251 County Road 120, Saint Cloud, MN 56303-4872 | 2020-02-13 |
| 1952870339 | Ellyn Marie Phearman | Physician Assistant | 251 County Road 120, Saint Cloud, MN 56303-4872 | 2018-11-15 |
| 1528535390 | Kellee Rucks | Family Medicine | 251 County Road 120, Saint Cloud, MN 56303-4872 | 2018-10-30 |
| 1700399649 | Joan Marie Kotila | Registered Nurse | 251 County Road 120, Saint Cloud, MN 56303-4872 | 2017-11-14 |
| 1952849069 | Christina Ringsmuth Mohs | Physician Assistant | 251 County Road 120, Saint Cloud, MN 56303-4872 | 2017-02-09 |
| 1225576598 | Jessica Barto | Nurse Practitioner | 251 County Road 120, Saint Cloud, MN 56303-4872 | 2017-02-07 |
| 1669829164 | Matthew Tembrock | Physical Therapist | 251 County Road 120, Suite A, Saint Cloud, MN 56303-4872 | 2016-05-16 |
| 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 | 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 |
| 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 |
| 1457405763 | Centracare Clinic | Clinic/Center | 1900 Centracare Cir, Suite 1450, Saint Cloud, MN 56303-5000 | 2007-01-23 |
| 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.