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Centracare Clinic

Organization Active NPI Multi-Specialty Clinic/Center · Big Lake, MN

NPI 1013104348 · NPPES record last updated Nov 19, 2020

Key facts

NPI
1013104348
Entity type
Organization (NPI type 2)
Primary specialty
Multi-Specialty Clinic/Center 261QM1300X
Legal business name
CENTRACARE CLINIC
Practice address
16830 198TH Ave NW
Centracare Clinic - Big Lake
Big Lake, MN 55309-4860
Phone
(763) 263-7300
Fax
(763) 263-7338
NPI assigned
Oct 1, 2007
Organization subpart
Yes
Parent organization (as reported)
CENTRACARE CLINIC

Authorized official

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

Other NPIs on the same Medicare enrollment 26

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

View all 26

Other NPIs with the same Medicare PAC ID 13

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

Corporate family (same tax ID) 11

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners 817

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

View all 817

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D1080211Centracare - Big Lake
16830 198TH Ave NW, Big Lake, MN 55309		Certificate of waiverFeb 28, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MN

Medicare enrollment records

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
O20141010001588 MN DME Supplier - Physician - General Practice 2466363395 1 other NPI on this enrollment
Practice locations: Big Lake, MN

National Provider Directory

Tax ID family
Clearwater Express Care (12 organizations share this tax ID)
Part of
Clearwater Express Care

Locations

200 Park Ln
Buffalo, MN 55313
Phone (763) 682-1131

1209 Sandy Ln
Monticello, MN 55362
Phone (763) 295-4856

3701 12th St N
Ste 102
Saint Cloud, MN 56303
Phone (320) 654-8353

1900 Centracare Cir
Ste 2375
Saint Cloud, MN 56303
Phone (320) 654-3633

113 Waite Ave S
Ste 101
Waite Park, MN 56387
Phone (320) 656-7127

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Yes
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

16830 198TH Ave NW
Centracare Clinic - Big Lake
Big Lake, MN 55309-4860

Mailing address

1200 6TH Ave N
Saint Cloud, MN 56303-2736
Phone (320) 229-4977

Other names

  • CentraCare - Big Lake Clinic Doing business as

Other providers in Big Lake, MN

All providers in Big Lake, MN · Multi-Specialty Clinic/Center in Minnesota

Sources for this page

Verify at the official NPI Registry.