NPIMap

Organization Active NPI

Brainerd Medical Center Inc

Doing business as Essentia Health Brainerd Pharmacy

  • Clinic Pharmacy
  • Brainerd, MN
National Provider Identifier
1053342329
Registry record updated Feb 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
Legal business name
BRAINERD MEDICAL CENTER INC
Doing business as
Essentia Health Brainerd Pharmacy
Practice address
2024 S 6TH St
Brainerd, MN 56401-4529
Phone
(218) 829-7455
Fax
(218) 855-5205
NPI assigned
Jul 5, 2006
Reactivated
Sep 14, 2021
Last updated
Feb 23, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ESSENTIA HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 23, 2024

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

Authorized official

Name
Kevin Boren
Title
VP of Finance
Phone
(218) 786-1009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X MN Primary

Addresses

Primary practice location

2024 S 6TH St
Brainerd, MN 56401-4529

Mailing address

204 Belknap St
Atn: Pharmacy Services
Superior, WI 54880-2905
Phone (218) 786-4265

Other names 1

  • Essentia Health Brainerd Pharmacy Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930023491 MN DME Supplier - Pharmacy 0648270272 Practice locations: Brainerd, MN
O20171013000866 MN Part B Supplier - Mass Immunization (Roster Biller Only) 0648270272 6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Baxter, MN; Brainerd, MN; Deerwood, MN; Pequot Lakes, MN; Pine River, MN; Staples, MN

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 6

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

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Essentia Health Brainerd Pharmacy2024 S 6TH St, Brainerd, MN 56401-4529(218) 829-7455 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) Accepts assignmentParticipating since Jan 2, 2007

National Provider Directory

National Provider Directory
Tax ID family
Brainerd Medical Center Inc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708646400000",
    "number": "1053342329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 BELKNAP ST",
            "address_2": "ATN: PHARMACY SERVICES",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548802905",
            "telephone_number": "218-786-4265",
            "fax_number": "218-786-2198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2024 S 6TH ST",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564014529",
            "telephone_number": "218-829-7455",
            "fax_number": "218-855-5205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAINERD MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESSENTIA HEALTH",
        "enumeration_date": "2006-07-05",
        "last_updated": "2024-02-23",
        "certification_date": "2024-02-23",
        "deactivation_date": "2021-09-03",
        "reactivation_date": "2021-09-14",
        "status": "A",
        "authorized_official_last_name": "BOREN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "218-786-1009"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Brainerd Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Essentia Health Brainerd Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brainerd, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2024; 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.