CENTRACARE CLINIC (NPI# 1881696490) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881696490 |
| Entity Type | Organization |
| Organization Name | CENTRACARE CLINIC |
| Other Organization Name | CENTRACARE CLINIC - NORTHWAY FAMILY MEDICINE |
| Practice Address |
1555 Northway Drive St Cloud MN 56303 |
| Practice Telephone | 3202511775 |
| Practice Fax Number | 3202403131 |
| Mailing Telephone | 3202511775 |
| Mailing Fax Number | 3202403131 |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2013-03-26 |
| Authorized Official Name | MR. 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 | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| HEALTH PARTNERS | 35580 | 01 | |
| BCBS | 86D71CE | 01 | |
| PREF ONE | NA131 | 01 | |
| MEDICA | 98-01806 | 01 | |
| UCARE | 110963 | 01 | |
| MN | 990228700 | 05 |
| Other Name | Type Code |
|---|---|
| CentraCare Clinic - Northway Family Medicine | 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 |
1555 NORTHWAY DRIVE |
| City | ST CLOUD |
| State | MN |
| Zip Code | 56303 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891077475 | Nicole Ann Ouke | Nurse Practitioner | 1555 Northway Drive, Suite 200, St Cloud, MN 56303-4913 | 2011-09-09 |
| 1487847752 | Endodontic Professionals Pa St Cloud Endodontics | Dentist | 1555 Northway Drive, Suite 210, St Cloud, MN 56303 | 2007-08-21 |
| 1366580136 | Jimmie Lewis Browning | Family Medicine | 1555 Northway Drive, Suite 200, St Cloud, MN 56303-4913 | 2007-02-02 |
| 1508885013 | Dennis L Peterson | Family Medicine | 1555 Northway Drive, Suite 200, St Cloud, MN 56303-4913 | 2006-07-18 |
| 1285660548 | Kevin R Switzer | Family Medicine | 1555 Northway Drive, Suite 200, St Cloud, MN 56303-4913 | 2006-06-25 |
| 1326097882 | Paul M Wenner | Psychologist | 1555 Northway Drive, Suite 200, St Cloud, MN 56303-4913 | 2006-05-10 |
| 1770532426 | St. Cloud Hospital | Clinic/Center | 1555 Northway Drive, Suite 200, St Cloud, MN 56303-4913 | 2006-05-09 |
| 1316915325 | Joseph M Blonski | Family Medicine | 1555 Northway Drive, Suite 200, St Cloud, MN 56303-4913 | 2006-03-08 |
| 1851369862 | Thomas John Satre | Family Medicine | 1555 Northway Drive, Suite 200, St Cloud, MN 56303-4913 | 2006-03-08 |
| 1013984491 | Penny L Rubesh | Nurse Practitioner | 1555 Northway Drive, Suite 200, St Cloud, MN 56303-4913 | 2006-03-03 |
| 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 | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043212665 | Centracare Clinic | Clinic/Center | 1200 Sixth Ave No, Centracare Clinic, St Cloud, MN 56303-2735 | 2005-08-12 |
| 1295910727 | Centracare Clinic | Clinic/Center | 1586 County Road 134, Centracare Clinic Sleep Center, St Cloud, MN 56303 | 2008-01-03 |
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|---|---|---|---|---|
| 1245855162 | The Duluth Clinic Ltd | Clinic/Center | 1600 Miller Trunk Hwy Ste 1300, Duluth, MN 55811-5640 | 2020-06-16 |
| 1184250060 | Premise Health of Minnesota Medical P C | Clinic/Center | 1906 8th St Nw, Austin, MN 55912-2473 | 2020-03-23 |
| 1053952606 | Fairview Express Care | Clinic/Center | 2512 6th Street, Suite F105, Minneapolis, MN 55454-1401 | 2019-10-04 |
| 1730731464 | St Marys Regional Health Center | Clinic/Center | 1103 1st St E, Park Rapids, MN 56470 | 2019-07-12 |
| 1003478892 | The Duluth Clinic Ltd | Clinic/Center | 4289 Ugstad Rd, Hermantown, MN 55811-3615 | 2019-07-02 |
| 1073005856 | Arbor Integrative Behavioral Health | Clinic/Center | 1000 E 1st St Ste 105, Duluth, MN 55805-2297 | 2018-06-06 |
| 1689161077 | Chs Tennessee Medical P C | Clinic/Center | 701 Brooks Ave S, Thief River Falls, MN 56701-2757 | 2018-04-20 |
| 1427557867 | Gillette Children's Specialty Healthcare | Clinic/Center | 505 Paul Bunyan Dr Nw, Bemidji, MN 56601-2400 | 2018-02-11 |
| 1992224331 | Orthopedic & Sports Physical Therapy, Inc. | Clinic/Center | 322 N Tower Rd, Fergus Falls, MN 56537-1015 | 2017-09-18 |
| 1003339789 | Centracare Clinic | Clinic/Center | 2025 Stearns Way Ste 114, Saint Cloud, MN 56303 | 2017-07-25 |
| 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.