NPIMap

Individual provider Active NPI

Bobbie Jo Bertram, RN, CNP

  • Family Nurse Practitioner
  • Saint Cloud, MN
National Provider Identifier
1275844011
Registry record updated Feb 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R156834 Issued in MN
Practice address
1406 6TH Ave N
St. Cloud Hospital
Saint Cloud, MN 56303-1900
Phone
(320) 255-5656
Fax
(320) 656-7044
NPI assigned
Jun 26, 2010
Last updated
Feb 14, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R-156834-7 MN
Family Nurse Practitioner 363LF0000X R156834 MN Primary

Addresses

Primary practice location

1406 6TH Ave N
St. Cloud Hospital
Saint Cloud, MN 56303-1900

Mailing address

1406 6TH Ave N
St. Cloud Hospital
Saint Cloud, MN 56303-1900
Phone (320) 255-5656

Other identifiers 1

IdentifierTypeStateIssuer
PENDMedicaidMN

Other names 1

  • Ms. Bobbie Jo Banken Former name

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
I20101015001094 MN Practitioner - Nurse Practitioner 3678766177 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Cloud HospitalGroup PAC ID 4880594779, 215 clinicians
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

110 2ND St S
Suite 104
Waite Park, MN 56387-1367
Phone (320) 259-9375

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

1406 6TH Ave N
Saint Cloud, MN 56303-1900
Phone (320) 251-2700

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

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
1652MNMDNeonatal/Pediatric Registered Respiratory Therapist
R-156834-7MNMDFamily Nurse Practitioner
R156834MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic Current Accepting new patients
St. Cloud Hospital Current Accepting new patients
Centracare Health Systems Current Accepting new patients
St Cloud Pathologists PA Current Accepting new patients
Regional Diagnostic Radiology Current Accepting new patients
St. Cloud Hospital CurrentSince Dec 1, 2012 Accepting new patients
Centracare Clinic Past Accepting new patients
Centracare Clinic Past Accepting new patients

Locations

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

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

1301 33rd St S
Saint Cloud, MN 56301
Phone (320) 240-6955

1406 6th Ave N
Saint Cloud, MN 56303
Phone (320) 255-5657

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

110 2nd St S
Ste 104
Waite Park, MN 56387
Phone (320) 259-9375

Interoperability endpoints

  • Direct secure messaging: bbertram23428@direct.centracare.com

Ownership & related parties

All facility ownership & control disclosures 30

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
St Cloud HospitalSaint Cloud, MN, CCN 240036 Hospital Corporate Director Jul 1, 2011
Centracare - Melrose HospitalMelrose, MN, CCN 241330 Hospital Corporate Director Jul 1, 2015
Centracare - Long Prairie HospitalLong Prairie, MN, CCN 241326 Hospital Corporate Director Jul 1, 2021
Centracare - Melrose Swing BedMelrose, MN, CCN 24Z330 Hospital Corporate Director Jul 1, 2015
Centracare - Long Prairie Swing BedLong Prairie, MN, CCN 24Z326 Hospital Corporate Director Jul 1, 2015
Centracare - St Cloud Hospital Inpatient RehabilitationSaint Cloud, MN, CCN 24T036 Hospital Corporate Director Jul 1, 2015
Centracare - Monticello HospitalMonticello, MN, CCN 241362 Hospital Corporate Director Jul 1, 2015
Centracare - Monticello Swing BedMonticello, MN, CCN 24Z362 Hospital Corporate Director Jul 1, 2015
Centracare - Paynesville Swing BedPaynesville, MN, CCN 24Z349 Hospital Corporate Director Jul 1, 2021
Centracare - Paynesville HospitalPaynesville, MN, CCN 241349 Hospital Corporate Director Jun 30, 2021
Centracare - Sauk Centre HospitalSauk Centre, MN, CCN 241368 Hospital Corporate Director Jul 1, 2021
Centracare - Monticello HospitalMonticello, MN, CCN 24M362 Hospital Corporate Officer Jun 30, 2021
Centracare - Rice Memorial HospitalWillmar, MN, CCN 240088 Hospital Corporate Director Jul 1, 2015
Centracare - RedwoodRedwood Falls, MN, CCN 24Z351 Hospital Corporate Director Jul 1, 2015
Centracare - RedwoodRedwood Falls, MN, CCN 241351 Hospital Corporate Director Jul 1, 2015
Centracare - Sauk Centre Swing BedSauk Centre, MN, CCN 24Z368 Hospital Corporate Director Jul 1, 2015
Centracare - BensonBenson, MN, CCN 24Z365 Hospital Corporate Director Jul 1, 2015
Centracare - BensonBenson, MN, CCN 241365 Hospital Corporate Director Jul 1, 2015
Centracare Home HealthWaite Park, MN, CCN 247117 Home health agency Corporate Director Jul 1, 2015
Centracare Home HealthRedwood Falls, MN, CCN 247229 Home health agency Corporate Director Jul 1, 2015
Centracare HospiceWaite Park, MN, CCN 241500 Hospice Corporate Director Jul 1, 2015
Centracare HospiceWillmar, MN, CCN 241509 Hospice Corporate Director Jul 1, 2015
Centracare HospiceRedwood Falls, MN, CCN 241517 Hospice Corporate Director Nov 5, 1979
Centracare - Long Prairie ClinicLong Prairie, MN, CCN 243451 Rural health clinic Corporate Director Jul 1, 2015
Centracare - Melrose ClinicMelrose, MN, CCN 243454 Rural health clinic Corporate Director Jul 1, 2021
Centracare - Sauk Centre ClinicSauk Centre, MN, CCN 243465 Rural health clinic Corporate Director Jul 1, 2015
Centracare - Paynesville ClinicPaynesville, MN, CCN 243487 Rural health clinic Corporate Director Jul 1, 2015
Centracare Paynesville - Richmond ClinicRichmond, MN, CCN 243488 Rural health clinic Corporate Director Jul 1, 2015
Centracare - RedwoodRedwood Falls, MN, CCN 243489 Rural health clinic Corporate Director Jul 1, 2015
Centracare-BensonBenson, MN, CCN 243478 Rural health clinic Corporate Director Jul 1, 2015

Owned or controlled facilities with NPI records 37

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 37

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, 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": "1277510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392336000000",
    "number": "1275844011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1406 6TH AVE N",
            "address_2": "ST. CLOUD HOSPITAL",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031900",
            "telephone_number": "320-255-5656",
            "fax_number": "320-656-7044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1406 6TH AVE N",
            "address_2": "ST. CLOUD HOSPITAL",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031900",
            "telephone_number": "320-255-5656",
            "fax_number": "320-656-7044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERTRAM",
        "first_name": "BOBBIE",
        "middle_name": "JO",
        "name_prefix": "Mrs.",
        "credential": "RN, CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-26",
        "last_updated": "2014-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "R-156834-7",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "R156834",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PEND",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BOBBIE",
            "last_name": "BANKEN",
            "middle_name": "JO",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.