Individual provider Active NPI

Diane M Cragoe, LMFT

  • Marriage & Family Therapist
  • Stillwater, MN
National Provider Identifier
1063526762
Registry record updated Jun 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
0869 Issued in MN
Practice address
1875 Northwestern Ave S
Stillwater, MN 55082
Phone
(651) 439-4840
Fax
(651) 439-4840
NPI assigned
Aug 18, 2006
Last updated
Jun 17, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 0869 MN Primary

Addresses

Primary practice location

1875 Northwestern Ave S
Stillwater, MN 55082

Mailing address

12432 Marquess Way N
Lake Elmo, MN 55042

Other identifiers 3

IdentifierTypeStateIssuer
878520100MedicaidMA
28G34CROtherBCBS
1010159OtherPREFERRED ONE

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240229001714 MN Practitioner - Marriage and Family Therapist 1052756038 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
FamilymeansGroup PAC ID 9830085182, 12 clinicians

Practice addresses (Care Compare)

1875 Northwestern Ave S
Stillwater, MN 55082-7534
Phone (651) 439-4840

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0869MNMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Familymeans CurrentSince Jan 1, 2024 Accepting new patients

Locations

1875 Northwestern Ave S
Stillwater, MN 55082
Phone (651) 439-4840

1200 Hosford St
Ste 201
Hudson, WI 54016
Phone (651) 439-4840

Organizations & group practices 1

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": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750118400000",
    "number": "1063526762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12432 MARQUESS WAY N",
            "city": "LAKE ELMO",
            "state": "MN",
            "postal_code": "55042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1875 NORTHWESTERN AVE S",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "55082",
            "telephone_number": "651-439-4840",
            "fax_number": "651-439-4840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRAGOE",
        "first_name": "DIANE",
        "middle_name": "M",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-18",
        "last_updated": "2025-06-17",
        "certification_date": "2025-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "0869",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "878520100",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "28G34CR",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1010159",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stillwater, MN

Sources for this page

Verify at the official NPI Registry.