CENTRACARE CLINIC (NPI# 1790201739) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790201739 |
| Entity Type | Organization |
| Organization Name | CENTRACARE CLINIC |
| Other Organization Name | CENTRACARE CLINIC ANESTHESIA |
| Practice Address |
1200 6th Ave N Saint Cloud MN 56303-2735 |
| Practice Telephone | 3202525131 |
| Practice Fax Number | 3202402118 |
| Mailing Telephone | 3202525131 |
| Mailing Fax Number | 3202402118 |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2019-08-14 |
| Authorized Official Name | THOMAS M FELDHEGE (DIRECTOR OF FINANCE / TREASURER) |
| Authorized Official Telephone | 3202402152 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| CentraCare Clinic Anesthesia | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3701 12th St N Ste 202, Saint Cloud, MN 563032253 | 3202583090 |
| 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 |
1200 6TH AVE N |
| City | SAINT CLOUD |
| State | MN |
| Zip Code | 56303-2735 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902805518 | Paul Charles Peterson | Emergency Medicine | 1200 6th Ave N, Saint Cloud, MN 56303-2735 | 2005-07-15 |
| 1871127290 | Kayla Girgen | Dietitian, Registered | 1200 6th Ave N, Saint Cloud, MN 56303-2735 | 2020-02-25 |
| 1023640034 | Faith Kelly Dammann | Physician Assistant | 1200 6th Ave N, Saint Cloud, MN 56303-2736 | 2020-02-07 |
| 1538707377 | Alissa Wigen | Physician Assistant | 1200 6th Ave N, Saint Cloud, MN 56303-2735 | 2019-12-11 |
| 1639713290 | Jordan Lajoie | Nurse Practitioner | 1200 6th Ave N, Saint Cloud, MN 56303-2735 | 2019-11-06 |
| 1528602430 | Hannah Elise Osterndorf | Dietitian, Registered | 1200 6th Ave N, Saint Cloud, MN 56303-2735 | 2019-11-04 |
| 1558919100 | Mergitu Megersa Gemeda | Physician Assistant | 1200 6th Ave N, Saint Cloud, MN 56303-2736 | 2019-08-27 |
| 1659927879 | Jennifer Marie Bretscher | Physician Assistant | 1200 6th Ave N, Saint Cloud, MN 56303-2735 | 2019-08-13 |
| 1366094302 | Laura Verley | Registered Nurse | 1200 6th Ave N, Saint Cloud, MN 56303-2736 | 2019-07-10 |
| 1063074235 | Briana Gray | Pharmacist | 1200 6th Ave N, Internal Medicine, Saint Cloud, MN 56303-2735 | 2019-07-08 |
| 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 | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
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| 1992196307 | Austin Orthopedics & Sports Medicine | Clinic/Center | 14051 Burnhaven Dr Ste 100, Burnsville, MN 55337-4400 | 2015-02-08 |
| 1831599430 | Medifit Health, LLC | Clinic/Center | 9201 Quaday Ave Ne Ste 203, Otsego, MN 55330-6604 | 2014-09-02 |
| 1437567609 | Aligned Chiropractic Pa | Clinic/Center | 3408 E Lake St, Suite 120, Minneapolis, MN 55406-2175 | 2014-07-31 |
| 1316369911 | New Leaf Medical, Pllc | Clinic/Center | 3622 County Road 101 S, Wayzata, MN 55391-3424 | 2014-01-16 |
| 1861825093 | Active Feet, Foot & Ankle Health Center | Clinic/Center | 10995 Club West Pkwy Ste 300, Blaine, MN 55449-5861 | 2013-08-12 |
| 1841538808 | White Dandelion Chinese Medicine L.L.C. | Clinic/Center | 108 3rd St E, Northfield, MN 55057-2050 | 2013-01-27 |
| 1831409234 | Princeton Chiropractic Clinic LLC | Clinic/Center | 501 4th St S Ste 101, Princeton, MN 55371-4754 | 2010-10-19 |
| 1629252101 | Paula Allenburg, Ltd | Clinic/Center | 2415 Emerson Ave S, Minneapolis, MN 55405-2602 | 2007-12-20 |
| Find all providers with the same taxonomy | ||||
| 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.