NPIMap

Organization Active NPI

Centracare Clinic

Doing business as CentraCare - Coordinated Care Clinic

  • Multi-Specialty Clinic/Center
  • Saint Cloud, MN
National Provider Identifier
1003339789
Registry record updated Sep 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
CENTRACARE CLINIC
Doing business as
CentraCare - Coordinated Care Clinic
Practice address
3701 12TH St N Ste 102
Saint Cloud, MN 56303-2253
Phone
(320) 656-7195
NPI assigned
Jul 25, 2017
Last updated
Sep 14, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael A Blair
Title
Sr VP & Cfo
Phone
(320) 255-5665

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

3701 12TH St N Ste 102
Saint Cloud, MN 56303-2253

Mailing address

PO Box 735818
Chicago, IL 60673-5818
Phone (320) 252-5131

Other practice location 1

1555 Northway Dr Ste 110
Saint Cloud, MN 56303-1866
Phone (320) 255-7195

Other practice location 2

2025 Stearns Way Ste 114
Saint Cloud, MN 56303
Phone (320) 255-7195

Other names 1

  • CentraCare - Coordinated Care Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031105000293 MN Part B Supplier - Clinic/Group Practice 2466363395 Receives reassigned benefits from 1,127 practitioners
29 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 26

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 26

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D2147315Coordinated Care Clinic3701 12TH St N, Suite 102, Saint Cloud, MN 56303Certificate of waiverApr 16, 2028

National Provider Directory

National Provider Directory

Locations

1555 Northway Dr
Ste 110
Saint Cloud, MN 56303
Phone (320) 255-7195

Practitioners & affiliated clinicians

Practitioners 57

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 57

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1500940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789344000000",
    "number": "1003339789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735818",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735818",
            "telephone_number": "320-252-5131",
            "fax_number": "320-240-2118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3701 12TH ST N STE 102",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032253",
            "telephone_number": "320-656-7195"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1555 Northway Dr Ste 110",
            "address_purpose": "LOCATION",
            "city": "Saint Cloud",
            "state": "MN",
            "postal_code": "563031866",
            "country_code": "US",
            "telephone_number": "320-255-7195",
            "fax_number": "320-200-3245",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2025 Stearns Way Ste 114",
            "address_purpose": "LOCATION",
            "city": "Saint Cloud",
            "state": "MN",
            "postal_code": "56303",
            "country_code": "US",
            "telephone_number": "320-255-7195",
            "fax_number": "320-200-3245",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CENTRACARE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-25",
        "last_updated": "2026-09-14",
        "certification_date": "2026-09-14",
        "status": "A",
        "authorized_official_last_name": "BLAIR",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "SR VP & CFO",
        "authorized_official_telephone_number": "320-255-5665"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CentraCare - Coordinated Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Cloud, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.