NPIMap

Organization Active NPI

Centracare Health - Benson LLC

  • Rural Health Clinic/Center
  • Benson, MN
National Provider Identifier
1023728516
Registry record updated Jan 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CENTRACARE HEALTH - BENSON LLC
Practice address
1815 Wisconsin Ave
Benson, MN 56215-1653
Phone
(320) 843-4232
NPI assigned
Nov 25, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2023

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

Authorized official

Name
Michael Blair
Title
Sr. VP/Cfo
Phone
(320) 255-5665

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1815 Wisconsin Ave
Benson, MN 56215-1653

Mailing address

1406 6TH Ave N
Saint Cloud, MN 56303-1900
Phone (320) 251-2700

Other names 1

  • CentraCare - Benson Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20230112000151 MN Part A Provider - Rural Health Clinic 1850761685 Practice locations: Benson, MN
O20230411000460 MN Part B Supplier - Clinic/Group Practice 1850761685 Receives reassigned benefits from 86 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Benson, MN

Rural health clinic certification: CCN 243478

Legal name
CENTRACARE HEALTH - BENSON LLC
Doing business as
CENTRACARE-BENSON
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 13, 2017
Last certification
Feb 13, 2017
Ownership / control type
Non-profit – church related
Most recent change of ownership
Jan 1, 2023 (1 total)
Organization structure
LLCNon-profit
Incorporated
Jan 1, 2023 in MN
Enrollment address
1815 Wisconsin Ave
Benson, MN 56215-1653
Related CCNs
241365

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

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Centracare Health - Benson LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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.

Locations

1810 McKinney Ave
Benson, MN 56215
Phone (320) 843-2030

Ownership & related parties

All disclosed owners & managing parties 17

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 Jul 1, 2021
Thomas Knoblach Individual Corporate Director Jul 1, 2011
Michael a Blair Individual Corporate OfficerCeo/Sr. VP Sep 30, 2019
W-2 Managing EmployeeCeo/Sr. VP Sep 30, 2019
Jeffrey Gau Individual Corporate Director Jul 1, 2017
Renee S Frauendienst Individual Corporate DirectorBoard Member Jul 1, 2017
Jacob Lyons Individual Corporate Director Jul 1, 2024
Richard Wehseler Individual Corporate Director Apr 21, 2018
Bobbie Bertram Individual Corporate Director Jul 1, 2015
Kenneth D Holmen Individual Corporate OfficerCeo/Board Member Jun 30, 2015
Sherri Liebl Individual W-2 Managing EmployeeDirector of Revenue 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, For-profit 5% Or Greater Direct Ownership Interest Jan 1, 2023 100%
Bryan Rolph Individual Corporate Director Jul 1, 2019

Owners & managing parties with NPI records 7

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

Facilities with the same owner 28

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

View all 28

Change-of-ownership history 1

DateEventCounterparty
Jan 1, 2023 Change of OwnershipThis provider was the buyer Swift County - Benson Health ServicesCCN 243478, MN, NPI 1174077739

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 85

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

View all 85

NPI Registry JSON

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

{
    "created_epoch": "1669334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674604800000",
    "number": "1023728516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1406 6TH AVE N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031900",
            "telephone_number": "320-251-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 WISCONSIN AVE",
            "city": "BENSON",
            "state": "MN",
            "postal_code": "562151653",
            "telephone_number": "320-843-4232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRACARE HEALTH - BENSON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-25",
        "last_updated": "2023-01-25",
        "certification_date": "2023-01-25",
        "status": "A",
        "authorized_official_last_name": "BLAIR",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "SR. VP/CFO",
        "authorized_official_telephone_number": "320-255-5665"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CentraCare - Benson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Benson, MN

Sources for this page

Verify at the official NPI Registry.