NPIMap

Individual provider Active NPI

Mithun Raghu Suresh, M.D.

  • Internal Medicine Physician
  • Minneapolis, MN
National Provider Identifier
1326483702
Registry record updated Mar 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
60351 Issued in MN
Practice address
420 Delaware St SE
14-100 Phillips Wangensteen Building, MMC 284
Minneapolis, MN 55455-0341
Phone
(612) 625-5454
Fax
(612) 625-3238
NPI assigned
Apr 30, 2013
Last updated
Mar 14, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 14, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Internal Medicine Physician 207R00000X 60351 MN Primary

Addresses

Primary practice location

420 Delaware St SE
14-100 Phillips Wangensteen Building, MMC 284
Minneapolis, MN 55455-0341

Mailing address

420 Delaware St SE
MMC 284
Minneapolis, MN 55455-0341
Phone (612) 625-5454

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address msuresh374838@direct.centracare.com Direct

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
I20160830002979 MN Practitioner - Internal Medicine 7315242856 Reassigns benefits to 8 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Minnesota Medical School, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians
St Cloud HospitalGroup PAC ID 4880594779, 215 clinicians

Practice addresses (Care Compare)

1555 Northway Dr
100 Centra Care Clinic Northway Family
St Cloud, MN 56303-1258
Phone (320) 251-1775

1555 Northway Dr
Suite 200
Saint Cloud, MN 56303-4913
Phone (320) 240-3157

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
60351MNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Health System-NR LLC CurrentSince Feb 1, 2021 Accepting new patients
Fairview Health Services Current Accepting new patients
Centracare Clinic Current Accepting new patients
Centracare Health System - Long Prairie CurrentSince Jul 1, 2023 Accepting new patients
Centracare Health System-NR LLC CurrentSince Feb 1, 2021 Accepting new patients
Fairview Express Care CurrentSince Aug 10, 2016 Accepting new patients
Centracare Clinic CurrentSince Sep 1, 2017 Accepting new patients
Centracare Health System - Long Prairie CurrentSince Jul 1, 2023 Accepting new patients
Healtheast Medical Research Institute Internal Medicine CurrentSince Sep 22, 2018 Accepting new patients
Centracare Health System-NR LLC Current Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Fairview Health Services CurrentSince Aug 10, 2016 Accepting new patients
Healtheast Medical Research Institute CurrentSince Sep 22, 2018 Accepting new patients
Centracare Clinic CurrentSince Sep 1, 2017 Accepting new patients
St. Cloud Hospital Past Accepting new patients

Locations

50 Centracare Dr
Long Prairie, MN 56347
Phone (320) 732-2131

420 Delaware St SE
Ste MMC284
Minneapolis, MN 55455
Phone (612) 625-5454

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

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

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

1555 Northway Dr
Ste 100
Saint Cloud, MN 56303
Phone (320) 240-1775

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

1575 Beam Ave
Saint Paul, MN 55109
Phone (651) 232-7000

45 10th St W
Saint Paul, MN 55102
Phone (651) 232-3000

69 Exchange St W
Saint Paul, MN 55102
Phone (651) 232-1100

1925 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-0100

Interoperability endpoints

  • Direct secure messaging: msuresh374838@direct.centracare.com

Organizations & group practices 16

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.

View all 16

Hospital & facility affiliations 12

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": "1367280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678752000000",
    "number": "1326483702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 DELAWARE ST SE",
            "address_2": "MMC 284",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550341",
            "telephone_number": "612-625-5454",
            "fax_number": "612-625-3238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 DELAWARE ST SE",
            "address_2": "14-100 PHILLIPS WANGENSTEEN BUILDING, MMC 284",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550341",
            "telephone_number": "612-625-5454",
            "fax_number": "612-625-3238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SURESH",
        "first_name": "MITHUN",
        "middle_name": "RAGHU",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-04-30",
        "last_updated": "2023-03-14",
        "certification_date": "2023-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "60351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "msuresh374838@direct.centracare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "msuresh374838@direct.centracare.com",
            "address_1": "1200 6th Ave N",
            "city": "Saint Cloud",
            "state": "MN",
            "country_code": "US",
            "postal_code": "563032735",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.