Individual provider Active NPI

Bryce C Holmgren, M.D.

  • Anesthesiology Physician
  • Saint Cloud, MN
National Provider Identifier
1063464378
Registry record updated Jun 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
34843 Issued in MN
Practice address
1526 Northway Dr
Saint Cloud, MN 56303-1255
Phone
(320) 251-8385
NPI assigned
May 16, 2006
Last updated
Jun 14, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 34843 MN Primary

Addresses

Primary practice location

1526 Northway Dr
Saint Cloud, MN 56303-1255

Mailing address

14700 28TH Ave N
Suite 20
Plymouth, MN 55447-4835
Phone (763) 559-3779

Other identifiers 1

IdentifierTypeStateIssuer
179720400MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100602000231 MN Practitioner - Anesthesiology 1355322033 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of North Dakota School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centracare Clinic Southwest LLCGroup PAC ID 8426457946, 172 clinicians

Practice addresses (Care Compare)

101 Willmar Ave SW
Willmar, MN 56201-3556
Phone (320) 231-5000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic Southwest LLC CurrentSince Mar 1, 2025 Accepting new patients
Mayo Clinic CurrentSince Jan 11, 2025 Accepting new patients
Centracare Clinic Southwest LLC CurrentSince Mar 1, 2025 Accepting new patients
Mayo Clinic Current Accepting new patients

Locations

600 Peterson Pkwy
New London, MN 56273
Phone (320) 354-2222

200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

101 Willmar Ave SW
Willmar, MN 56201
Phone (320) 231-5079

Interoperability endpoints

  • Direct secure messaging: bholmgren873100@direct.centracare.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718323200000",
    "number": "1063464378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14700 28TH AVE N",
            "address_2": "SUITE 20",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554474835",
            "telephone_number": "763-559-3779",
            "fax_number": "763-450-3986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1526 NORTHWAY DR",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031255",
            "telephone_number": "320-251-8385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLMGREN",
        "first_name": "BRYCE",
        "middle_name": "C",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MN",
            "license": "34843",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "179720400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.