Samuel Thomas Goracke, CNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

10717 Issued in MN

Practice address

6500 Excelsior Blvd
St Louis Park, MN 55426-4702

Phone

(320) 424-0570

NPI assigned

Jun 19, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN, WI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Glacial Ridge Hospital DistrictGroup PAC ID 5294789194, shared by 7 NPIs, 69 clinicians

St. Croix Regional Medical CenterGroup PAC ID 9335032184, 131 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Croix Regional Medical Center Hospital, Saint Croix Falls, WI, CCN 521337
• Glacial Ridge Hospital Hospital, Glenwood, MN, CCN 241376

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

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

• St. Croix Regional Medical Center

  • Critical Access Hospital
  • Saint Croix Falls, WI
  • NPI 1043240922
  Medicare reassignment Care Compare group NPD
• Fairview Health Services

  • Emergency Medicine Physician
  • Minneapolis, MN
  • NPI 1811077175
  Medicare reassignment
• Glacial Ridge Hospital District

  • Family Medicine Physician
  • Brooten, MN
  • NPI 1255348223
  Medicare reassignment
• Glacial Ridge Hospital District

  • Critical Access Hospital
  • Glenwood, MN
  • NPI 1538178520
  Medicare reassignment
• Grand Itasca Clinic and Hospital

  • General Acute Care Hospital
  • Grand Rapids, MN
  • NPI 1669426631
  Medicare reassignment
• Range Regional Health Services

  • Clinic/Center
  • Hibbing, MN
  • NPI 1669569265
  Medicare reassignment
• St. Croix Regional Medical Center

  • Rural Health Clinic/Center
  • Balsam Lake, WI
  • NPI 1013423219
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Glacial Ridge Hospital District

  • Critical Access Hospital
  • Glenwood, MN
  • NPI 1538178520
  Care Compare affiliation
• St. Croix Regional Medical Center

  • Critical Access Hospital
  • Saint Croix Falls, WI
  • NPI 1043240922
  Care Compare affiliation

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

{
    "created_epoch": "1687132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695772800000",
    "number": "1144905159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S # MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6500 EXCELSIOR BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554264702",
            "telephone_number": "320-424-0570"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "640 Jackson St",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551012502",
            "country_code": "US",
            "telephone_number": "320-424-0570",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORACKE",
        "first_name": "SAMUEL",
        "middle_name": "THOMAS",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-19",
        "last_updated": "2023-09-27",
        "certification_date": "2023-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "00000000",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "10717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Annmarie Gonzalez, OTR
• Carrie Gonzalez, MPH, RD, LD
• Good Clinic MN PLLC
• Good Samaritan Care Center LLC
• Leah Simone Good, NP
• Carolyn M Gordon
• Natasha Rondano Gorecki
• Jill Gorius, MD
• Robert J Gorman, MD
• Brandi Marie Gossard, PHARMD

• Nurse Practitioner in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.