ST. CLOUD HOSPITAL (NPI# 1801845391) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801845391 |
| Entity Type | Organization |
| Organization Name | ST. CLOUD HOSPITAL |
| Other Organization Name | CENTRACARE KIDNEY PROGRAM - BIG LAKE DIALYSIS |
| Practice Address |
16830 198th Ave Nw Big Lake Clinic Big Lake MN 55309 |
| Mailing Address |
1406 6th Ave North Saint Cloud MN 56303-1900 |
| Practice Telephone | 7632637320 |
| Practice Fax Number | 3206567009 |
| Mailing Telephone | 3202512700 |
| Mailing Fax Number | 3206567009 |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2019-10-10 |
| Authorized Official Name | MR. MICHAEL A. BLAIR (SR. VICE PRESIDENT AND CFO) |
| Authorized Official Telephone | 3202555665 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QE0700X |
Clinic/Center Specialization: End-Stage Renal Disease (ESRD) Treatment |
331506 | MN | Ambulatory Health Care Facilities |
| Y | 261QE0700X |
Clinic/Center Specialization: End-Stage Renal Disease (ESRD) Treatment |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 883747300 | 05 |
| Other Name | Type Code |
|---|---|
| CentraCare Kidney Program - Big Lake Dialysis | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841616877 | St. Cloud Hospital | Substance Abuse Rehabilitation Facility | 1495 10th Ave Ne, Sauk Rapids, MN 56379 | 2014-03-14 |
| 1912338666 | St. Cloud Hospital | Rehabilitation, Substance Use Disorder Unit | 1428 2nd St N, Sauk Rapids, MN 56379-2533 | 2013-12-06 |
| 1780020925 | St. Cloud Hospital | Substance Abuse Rehabilitation Facility | 1572 Co Rd 134, St. Cloud, MN 56303-0346 | 2013-05-15 |
| 1811150618 | St. Cloud Hospital | Rehabilitation, Substance Use Disorder Unit | 1564 Cty Rd 134, St Cloud, MN 56303-0346 | 2008-07-02 |
| 1427218957 | St. Cloud Hospital | Substance Abuse Rehabilitation Facility | 1485 10th Ave Ne, Sauk Rapids, MN 56379-9838 | 2008-06-09 |
| 1033391099 | St. Cloud Hospital | Clinic/Center | 520 Hwy 12 East, Suite 6, Litchfield, MN 55355 | 2007-12-03 |
| 1316063233 | St. Cloud Hospital | Clinic/Center | 520 11th Ave Sw, South Building, Cambridge, MN 55008-2003 | 2007-03-22 |
| 1912956400 | St. Cloud Hospital | Clinic/Center | 2024 So 6th St, Brainerd, MN 56401 | 2006-05-10 |
| 1821047317 | St. Cloud Hospital | Clinic/Center | 2035 15th St N, Suite 220, Saint Cloud, MN 56303-1738 | 2006-05-10 |
| 1760431266 | St. Cloud Hospital | Clinic/Center | 111 17th Ave East, Alexandria, MN 56308 | 2006-05-10 |
| Street Address |
16830 198TH AVE NW BIG LAKE CLINIC |
| City | BIG LAKE |
| State | MN |
| Zip Code | 55309 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801873674 | Glenn W Weidenbacher | Pediatrics | 16830 198th Ave Nw, Big Lake Clinic, Big Lake, MN 55309 | 2005-12-22 |
| 1003226416 | Sarah E Johnson | Dietitian, Registered | 16830 198th Ave Nw, Centracare Clinic - Big Lake, Big Lake, MN 55309-4860 | 2014-05-07 |
| 1942438270 | Jessica L Hodson | Family Medicine | 16830 198th Ave Nw, Centracare Clinic Big Lake, Big Lake, MN 55309-4860 | 2009-06-25 |
| 1043479876 | Nabeel Bishara Ailabouni | Family Medicine | 16830 198th Ave Nw, Big Lake Clinic, Big Lake, MN 55309 | 2008-06-06 |
| 1013104348 | Centracare Clinic | Durable Medical Equipment & Medical Supplies | 16830 198th Ave Nw, Centracare Clinic - Big Lake, Big Lake, MN 55309-4860 | 2007-10-01 |
| 1720118912 | Luke A. Herdina | Physician Assistant | 16830 198th Ave Nw, Big Lake Clinic, Big Lake, MN 55309 | 2007-03-06 |
| 1417924994 | Lola B Sutherland | Family Medicine | 16830 198th Ave Nw, Big Lake Clinic, Big Lake, MN 55309 | 2006-03-03 |
| 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 | 261QE0700X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | End-Stage Renal Disease (ESRD) Treatment |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770183832 | Bio-medical Applications of Minnesota, Inc. | Clinic/Center | 6160 Summit Dr N Ste 150, Brooklyn Center, MN 55430-2118 | 2020-10-28 |
| 1902392111 | Chaffee Dialysis LLC | Clinic/Center | 862 Arcade St, Saint Paul, MN 55106 | 2018-07-11 |
| 1225541055 | Bio-medical Applications of Minnesota, Inc. | Clinic/Center | 7433 Currell Blvd, Woodbury, MN 55125-2217 | 2017-11-15 |
| 1154856839 | Avera Marshall | Clinic/Center | 300 S Bruce St Ste D, Marshall, MN 56258-1934 | 2017-05-01 |
| 1225573777 | Atlantic Dialysis LLC | Clinic/Center | 1802 Commerce Dr, North Mankato, MN 56003-1800 | 2016-12-19 |
| 1437694981 | Atlantic Dialysis LLC | Clinic/Center | 701 N Broadway St, New Ulm, MN 56073-1201 | 2016-12-19 |
| 1467801860 | Total Renal Care, Inc. | Clinic/Center | 20184 Heritage Dr, Lakeville, MN 55044-6855 | 2016-06-07 |
| 1003292392 | Bio-medical Applications of Minnesota, Inc. | Clinic/Center | 17592 Dodd Blvd, Lakeville, MN 55044-3909 | 2015-08-10 |
| 1629461470 | Babler Dialysis, LLC | Clinic/Center | 2660 S Broadway, Ste A, Rochester, MN 55904-6263 | 2015-03-17 |
| 1588067391 | Meesa Dialysis LLC | Clinic/Center | 245 Isle St W, Isle, MN 56342-4908 | 2014-10-07 |
| 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.