NPIMap

Individual provider Active NPI

Bryce Mieczkowski, D.O.

  • Anesthesiology Physician
  • Saint Cloud, MN
National Provider Identifier
1235518903
Registry record updated May 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
65396 Issued in MN
Practice address
3701 12TH St N Ste 202
Saint Cloud, MN 56303-2253
Phone
(320) 258-3090
Fax
(320) 258-3095
NPI assigned
May 27, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 390200D00X OH
Anesthesiology Physician 207L00000X 65396 MN Primary

Addresses

Primary practice location

3701 12TH St N Ste 202
Saint Cloud, MN 56303-2253

Mailing address

3701 12TH St N Ste 202
Saint Cloud, MN 56303-2253
Phone (320) 258-3090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, MT2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190711001504 MN Practitioner - Anesthesiology 5092021618 Reassigns benefits to 1 organization
I20201006002959 MT Practitioner - Anesthesiology 5092021618 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Rocky Vista University College of Osteopathic Med, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Logan Health - WhitefishGroup PAC ID 9335033687, shared by 6 NPIs, 48 clinicians
Northern Rockies Anesthesia Consultants PLLCGroup PAC ID 8022900208, 33 clinicians

Practice addresses (Care Compare)

1600 Hospital Way
Whitefish, MT 59937-7849
Phone (406) 863-3500

3004 Hospital Way
Whitefish, MT 59937-7838
Phone (406) 862-4763

310 Sunnyview LN
Kalispell, MT 59901-3129
Phone (406) 752-5111

Hospital & facility affiliations

  • Logan Health Medical Center Hospital, Kalispell, MT, CCN 270051
  • Logan Health - Whitefish Hospital, Whitefish, MT, CCN 271336

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
390200D00XOHMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Valley Hospital, Inc CurrentSince Jan 1, 2023 Accepting new patients
Logan Health - Whitefish Current Accepting new patients
Logan Health - Whitefish CurrentSince Jan 1, 2023 Accepting new patients
Centracare Clinic CurrentSince Aug 1, 2019 Accepting new patients
Centracare Clinic CurrentSince Aug 1, 2019 Accepting new patients
Centracare Clinic Current Accepting new patients
Northern Rockies Anesthesia Consultants PLLC Anesthesiology CurrentSince Sep 17, 2020 Accepting new patients
Centracare Clinic Past Accepting new patients

Locations

3701 12th St N
Ste 202
Saint Cloud, MN 56303
Phone (320) 258-3090

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

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

320 Sunnyview Ln
Kalispell, MT 59901
Phone (406) 752-7441

310 Sunnyview Ln
Kalispell, MT 59901
Phone (406) 751-5310

106 Ridgewater Dr
Ste A
Polson, MT 59860
Phone (406) 883-3200

1600 Hospital Way
Whitefish, MT 59937
Phone (406) 863-3500

3004 Hospital Way
Whitefish, MT 59937
Phone (406) 862-4763

Interoperability endpoints

  • Direct secure messaging: bmieczkowski462975@direct.centracare.com

Organizations & group practices 8

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.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1432684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557792000000",
    "number": "1235518903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3701 12TH ST N STE 202",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032253",
            "telephone_number": "320-258-3090",
            "fax_number": "320-258-3095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3701 12TH ST N STE 202",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032253",
            "telephone_number": "320-258-3090",
            "fax_number": "320-258-3095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIECZKOWSKI",
        "first_name": "BRYCE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-27",
        "last_updated": "2019-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OH",
            "license": "390200D00X",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MN",
            "license": "65396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.