St. Mary'S Regional Health Center
Organization Active NPI Family Medicine Physician · Frazee, MN
NPI 1275977928 · NPPES record last updated Oct 1, 2021
Key facts
- NPI
- 1275977928
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- ST. MARY'S REGIONAL HEALTH CENTER
- Practice address
- 300 Main Ave E
Frazee, MN 56544 - Phone
- (218) 334-7255
- NPI assigned
- Apr 24, 2013
- Organization subpart
- Yes
- Parent organization (as reported)
- ST. MARY'S REGIONAL HEALTH CENTER
Authorized official
- Name
- Tanner Goodrich
- Title
- President
- Phone
- (218) 847-5611
Parent organization (reported in NPPES) 1
Other NPIs on the same Medicare enrollment 13
Member of 1
Practitioners 21
-
Kia Danielle Alton, SLP
-
Lisa D Bojado, NP
-
Michelle R England, MSW
-
Carrie Amanda Lahr, APRN/CNP
-
Carol M Lee, CRNA
-
Kathryn L Nevins, CNP
-
Macey Schaefbauer, PA-C
-
Heather Jan Schultz, M.A., CCC-SLP
-
Benjamin C Smith, MD
-
Nancy Ann Trickey, LICSW
-
Jacob Mack Babel, DO
-
John W Belk, DO
-
Lisa M Jostad, APRN,CNP
-
Bess J. Martin, PHD, LP
-
Richard T Vetter, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031117000090 | MN | Part B Supplier - Clinic/Group Practice | 2062326820 |
Receives reassigned benefits from 290 practitioners 13 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Frazee, MN; Lake Park, MN; Mahnomen, MN; Menahga, MN; Park Rapids, MN; Pelican Rapids, MN; Walker, MN; Detroit Lakes, MN |
National Provider Directory
- Part of
- St Marys Regional HLTH
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
300 Main Ave E
Frazee, MN 56544
Mailing address
1027 Washington Ave
Detroit Lakes, MN 56501-3409
Phone (218) 334-7255
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 892442000 | Medicaid | MN |
Other names
- Essentia Health St. Mary's - Frazee Clinic
Other providers in Frazee, MN
- Dena Corrine Mekalson
- Seip Drug LLC
- Lori Ann Sorenson
- Sprout Therapy Services LLC
- St Mary'S Regional Health Center
- Wendy Ann Stiegel
- Paul Sweere
- Lori Vigesaa
- Whitney'S Wings, LLC
All providers in Frazee, MN · Family Medicine Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 1, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.