NPIMap

Organization Active NPI

Central Minnesota Mental Health Center

  • Addiction (Substance Use Disorder) Counselor
  • Elk River, MN
National Provider Identifier
1114048170
Registry record updated Jul 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
809836-3-CDT Issued in MN
Legal business name
CENTRAL MINNESOTA MENTAL HEALTH CENTER
Practice address
730 Dodge Ave NW
Suite 101
Elk River, MN 55330-1926
Phone
(763) 441-3770
Fax
(763) 441-9057
NPI assigned
Apr 3, 2007
Last updated
Jul 21, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2008

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

Authorized official

Name
David Baraga, PH.D, LPNPI 1679519789
Title
Executive Director
Phone
(320) 202-2033

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X 809836-3-CDT MN Primary

Addresses

Primary practice location

730 Dodge Ave NW
Suite 101
Elk River, MN 55330-1926

Mailing address

1321 13TH St N
Saint Cloud, MN 56303-2613
Phone (320) 252-5010

Other identifiers 1

IdentifierTypeStateIssuer
127824000OtherMNPROVIDER NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040119000248 MN Part B Supplier - Clinic/Group Practice 4486555877 Receives reassigned benefits from 47 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Monticello, MN; Waite Park, MN; Saint Cloud, MN; Elk River, MN; Buffalo, MN

Other NPIs on the same Medicare enrollment 12

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

National Provider Directory

National Provider Directory

Locations

730 Dodge Ave NW
Ste 101
Elk River, MN 55330
Phone (763) 441-3770

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216598400000",
    "number": "1114048170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1321 13TH ST N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032613",
            "telephone_number": "320-252-5010",
            "fax_number": "320-203-1855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 DODGE AVE NW",
            "address_2": "SUITE 101",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553301926",
            "telephone_number": "763-441-3770",
            "fax_number": "763-441-9057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL MINNESOTA MENTAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2008-07-21",
        "status": "A",
        "authorized_official_last_name": "BARAGA",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "320-202-2033",
        "authorized_official_credential": "PH.D, LP"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "809836-3-CDT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NUMBER",
            "identifier": "127824000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elk River, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.