NPIMap

Organization Active NPI

Centracare Health System-NR LLC

  • Psychiatric Hospital Unit
  • Monticello, MN
National Provider Identifier
1003353202
Registry record updated Oct 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
CENTRACARE HEALTH SYSTEM-NR LLC
Practice address
1013 Hart Blvd
Monticello, MN 55362-8575
Phone
(763) 295-2945
Fax
(763) 271-2299
NPI assigned
Jan 25, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2019

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

Authorized official

Name
Mr. Michael A. Blair
Title
Sr. Vice President and Cfo
Phone
(320) 255-5665

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X Primary

Addresses

Primary practice location

1013 Hart Blvd
Monticello, MN 55362-8575

Mailing address

1013 Hart Blvd
Monticello, MN 55362-8575
Phone (763) 295-2945

Other names 1

  • Geriatric Behavioral Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130515000683 MN Part B Supplier - Clinic/Group Practice 3870739410 Receives reassigned benefits from 320 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Monticello, MN
O20170615000046 MN Part A Provider - Critical Access Hospital 3870739410 Practice locations: Monticello, MN

Hospital certification: CCN 24M362

Legal name
CENTRACARE HEALTH SYSTEM-NR LLC
Doing business as
CENTRACARE - MONTICELLO HOSPITAL
Organization structure
LLCNon-profit
Incorporated
Nov 29, 2012 in MN
Enrollment address
1013 Hart Blvd
Ste 1
Monticello, MN 55362-8575

Facilities connected through Provider of Services related, parent or unit certification numbers.

All disclosed owners & managing parties 17

Medicare enrollment files

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Tina SSN May Individual Corporate Director Jul 1, 2025
Michelle Johnson Individual Corporate Director Jun 30, 2021
Thomas Knoblach Individual Corporate Officer Jun 30, 2021
Michael a Blair Individual Corporate OfficerCfo Sep 30, 2019
W-2 Managing Employee Sep 30, 2019
Jeffrey Gau Individual Corporate Director Jul 1, 2017
Renee S Frauendienst Individual Corporate Director Jul 1, 2017
Jacob Lyons Individual Corporate Director Jul 1, 2024
Richard Wehseler Individual Corporate Director Apr 21, 2018
Bobbie Bertram Individual Corporate Officer Jun 30, 2021
Kenneth D Holmen Individual Corporate OfficerCeo, Centracare Health System Jun 1, 2017
Corporate DirectorBoard Member Jun 1, 2017
Sherri Liebl Individual Corporate OfficerExecutive Director Sep 30, 2019
David Anfinson Individual Corporate Director Apr 21, 2018
Daniel Abdul Individual Corporate Director Jul 1, 2022
James Hebl Individual Corporate Director Jul 1, 2017
Carrie Henning-Smith Individual Corporate Director Jul 1, 2023
Centracare Health System Organization, Saint Cloud, MN Corporation, Non-profit Operational/Managerial Control Jun 1, 2017
Bryan Rolph Individual Corporate Officer Jul 1, 2019

National Provider Directory

National Provider Directory

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Other NPIs on the same Medicare enrollment 3

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

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Facilities with the same owner 28

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 28

Practitioners 133

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 133

NPI Registry JSON

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

{
    "created_epoch": "1485302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570665600000",
    "number": "1003353202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1013 HART BLVD",
            "city": "MONTICELLO",
            "state": "MN",
            "postal_code": "553628575",
            "telephone_number": "763-295-2945",
            "fax_number": "763-271-2299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1013 HART BLVD",
            "city": "MONTICELLO",
            "state": "MN",
            "postal_code": "553628575",
            "telephone_number": "763-295-2945",
            "fax_number": "763-271-2299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRACARE HEALTH SYSTEM-NR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-25",
        "last_updated": "2019-10-10",
        "status": "A",
        "authorized_official_last_name": "BLAIR",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "SR. VICE PRESIDENT AND CFO",
        "authorized_official_telephone_number": "320-255-5665",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Geriatric Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monticello, MN

Sources for this page

Verify at the official NPI Registry.