NPIMap

Individual provider Active NPI

Courtney Leigh Minadakis, PA-C

  • Physician Assistant
  • Saint Cloud, MN
National Provider Identifier
1245679695
Registry record updated Apr 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
11399 Issued in MN
Practice address
3701 12TH St N Ste 100
Saint Cloud, MN 56303-2253
Phone
(320) 253-7257
NPI assigned
Jun 19, 2013
Last updated
Apr 18, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 11399 MN Primary

Addresses

Primary practice location

3701 12TH St N Ste 100
Saint Cloud, MN 56303-2253

Mailing address

3701 12TH St N Ste 100
Saint Cloud, MN 56303-2253
Phone (320) 253-7257

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131024000238 MN Practitioner - Physician Assistant 9931334133 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

1200 6TH Ave N
Saint Cloud, MN 56303-2735

1200 6TH N Ave
Saint Cloud, MN 56303-2735
Phone (320) 252-5131

1406 6TH Ave N
St Cloud, MN 56303-1901

1406 6TH Ave No
St Cloud, MN 56303-1901

1900 Centracare Cir
Saint Cloud, MN 56303-5000

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

PO Box
Chicago, IL 60673

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11399MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic CurrentSince Jun 1, 2023 Accepting new patients
Centracare Health System-NR LLC CurrentSince Aug 1, 2023 Accepting new patients
Centracare Clinic CurrentSince Jun 1, 2023 Accepting new patients
Centracare Health System - Sauk Centre CurrentSince Aug 1, 2023 Accepting new patients
Centracare Health System - Melrose CurrentSince Aug 1, 2023 Accepting new patients
Centracare Health System - Melrose CurrentSince Aug 1, 2023 Accepting new patients
Centracare Health System-NR LLC CurrentSince Aug 1, 2023 Accepting new patients

Locations

525 Main St W
Melrose, MN 56352
Phone (320) 256-4228

1013 Hart Blvd
Monticello, MN 55362
Phone (763) 271-2303

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

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

3701 12th St N
Ste 100
Saint Cloud, MN 56303
Phone (320) 253-7257

425 Elm St N
Sauk Centre, MN 56378
Phone (320) 352-2221

Interoperability endpoints

  • Direct secure messaging: clogan@stcloudortho1831.srs-direct.com
  • Direct secure messaging: cminadakis739487@direct.centracare.com

Organizations & group practices 9

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.

Hospital & facility affiliations 6

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": "1371600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713398400000",
    "number": "1245679695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3701 12TH ST N STE 100",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032253",
            "telephone_number": "320-253-7257",
            "fax_number": "320-251-2938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3701 12TH ST N STE 100",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032253",
            "telephone_number": "320-253-7257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINADAKIS",
        "first_name": "COURTNEY",
        "middle_name": "LEIGH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-19",
        "last_updated": "2024-04-18",
        "certification_date": "2024-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "11399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.