Centracare Health System-NR LLC
Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Monticello, MN
NPI 1376883769 · NPPES record last updated Oct 10, 2019
Key facts
- NPI
- 1376883769
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medicare Defined Swing Bed Hospital Unit 275N00000X
- Legal business name
- CENTRACARE HEALTH SYSTEM-NR LLC
- Practice address
- 1013 Hart Blvd
Monticello, MN 55362-8575 - Phone
- (763) 295-2945
- Fax
- (763) 271-2299
- NPI assigned
- Feb 21, 2013
- Organization subpart
- No
Authorized official
- Name
- Mr. Michael A. Blair
- Title
- Sr. Vice President and Cfo
- Phone
- (320) 255-5665
Owners & managing parties with NPI records 7
-
Bobbie Jo Bertram, RN, CNP
-
James Russell Hebl, M.D.
-
Jacob Lyons, MD
-
Bryan P Rolph, MD
Other NPIs with the same Medicare PAC ID 3
Member of 1
Related certifications (CCN) 2
Facilities with the same owner 28
Practitioners 63
-
Malik Ahmad, M.D.
-
Vanessa L Baca, DO
-
Jacob Patrick Berwyn, PA-C
-
Jennifer Brewer, MD
-
Ryan Carlson, M.D.
-
Anjali Dahiya, M D
-
Kristi Rae Estabrook, M.D.
-
Shaun Fernandes, MD
-
Sade Marie Bell Finn, M.D.
-
Kaylle Rose Schmit Foley, CANP
-
Larry V Hook Jr., MD
-
Rajan Jhanjee, MD
-
Sriveer Kaasam, M.D.
-
Mark Kassebaum, MD
-
Joshua Michael Kenzie, CRNA
-
Jacob D Kotzian, CRNA
-
Robert Krieger, DO
Affiliated clinicians 3
-
Paul L Marek, MD, FHM
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Hospital certification: CCN 24Z362
- Legal name
- CENTRACARE HEALTH SYSTEM-NR LLC
- Doing business as
- CENTRACARE - MONTICELLO SWING BED
- Organization structure
- LLC · Non-profit
- Incorporated
- Nov 29, 2012 in MN
- Enrollment address
- 1013 Hart Blvd
Monticello, MN 55362-8575
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| Tina SSN May |
Corporate Director | Jul 1, 2025 | |
| Michelle Johnson |
Corporate Director | Jul 1, 2021 | |
| Thomas Knoblach |
Corporate Director | Jul 1, 2011 | |
| Michael a Blair |
Corporate Officer |
Sep 30, 2019 | |
| W-2 Managing Employee | Sep 30, 2019 | ||
| Jeffrey Gau |
Corporate Director | Jul 1, 2017 | |
| Renee S Frauendienst |
Corporate Director | Jul 1, 2017 | |
| Jacob Lyons |
Corporate Director | Jul 1, 2024 | |
| Richard Wehseler |
Corporate Director | Apr 21, 2018 | |
| Bobbie Bertram |
Corporate Director | Jul 1, 2015 | |
| Kenneth D Holmen |
Corporate Director | Jan 1, 2015 | |
| Sherri Liebl |
Corporate Officer |
Sep 30, 2019 | |
| David Anfinson |
Corporate Director | Apr 21, 2018 | |
| Daniel Abdul |
Corporate Director | Jul 1, 2022 | |
| James Hebl |
Corporate Director | Jul 1, 2017 | |
| Carrie Henning-Smith |
Corporate Director | Jul 1, 2023 | |
| Centracare Health System |
5% Or Greater Direct Ownership Interest | Apr 1, 2013 | 100% |
| Bryan Rolph |
Corporate Director | Jul 1, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130426000263 | MN | Part a Provider - Critical Access Hospital | 3870739410 | Practice locations: Monticello, MN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | Yes |
Addresses
Primary practice location
1013 Hart Blvd
Monticello, MN 55362-8575
Mailing address
1013 Hart Blvd
Monticello, MN 55362-8575
Phone (763) 295-2945
Other names
- CentraCare Health - Monticello Swing Bed
Other providers in Monticello, MN
- Lillian Carver
- Centracare Health Monticello Services LLC
- Centracare Health System - NR, LLC
- Centracare Health System-NR LLC
- Centracare Health System-NR LLC
- Centracare Health System-NR LLC
- Centracare Health System-NR LLC
- Centracare Health System-NR LLC
- Central Minnesota Mental Health Center
- Central Minnesota Mental Health Center
All providers in Monticello, MN · Medicare Defined Swing Bed Hospital Unit 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 10, 2019. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.