NPIMap

Organization Active NPI

Brainerd Medical Center Inc

Doing business as Essentia Health Brainerd Specialty Clinic

  • General Practice Physician
  • Brainerd, MN
National Provider Identifier
1295801777
Registry record updated Feb 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
8619454 Issued in MN
Legal business name
BRAINERD MEDICAL CENTER INC
Doing business as
Essentia Health Brainerd Specialty Clinic
Practice address
2024 S 6TH St
Brainerd, MN 56401-4529
Phone
(218) 828-7100
Fax
(218) 828-7194
NPI assigned
Nov 28, 2006
Reactivated
Sep 14, 2021
Last updated
Feb 26, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ESSENTIA HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 26, 2024

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

Authorized official

Name
Kevin Boren
Title
VP of Finance
Phone
(218) 786-1009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 8619454 MN Primary

Addresses

Primary practice location

2024 S 6TH St
Brainerd, MN 56401-4529

Mailing address

2024 S 6TH St
Brainerd, MN 56401-4529
Phone (218) 828-7100

Other names 1

  • Essentia Health Brainerd Specialty Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070105000140 MN Part B Supplier - Clinic/Group Practice 0648270272 Receives reassigned benefits from 145 practitioners
3 other NPIs on this enrollment
Practice locations: Baxter, MN; Brainerd, MN

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

2024 S 6th St
Brainerd, MN 56401
Phone (218) 828-2880

Practitioners & affiliated clinicians

Practitioners 151

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 151

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708905600000",
    "number": "1295801777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2024 S 6TH ST",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564014529",
            "telephone_number": "218-828-7100",
            "fax_number": "218-828-7194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2024 S 6TH ST",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564014529",
            "telephone_number": "218-828-7100",
            "fax_number": "218-828-7194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAINERD MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESSENTIA HEALTH",
        "enumeration_date": "2006-11-28",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "deactivation_date": "2021-09-03",
        "reactivation_date": "2021-09-14",
        "status": "A",
        "authorized_official_last_name": "BOREN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "218-786-1009"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MN",
            "license": "8619454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Brainerd Specialty Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Essentia Health Brainerd Specialty Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brainerd, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.