NPIMap

Organization Active NPI

Carris Health - Redwood LLC

  • Rural Health Clinic/Center
  • Redwood Falls, MN
National Provider Identifier
1396216412
Registry record updated Sep 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CARRIS HEALTH - REDWOOD LLC
Practice address
101 Caring Way
Redwood Falls, MN 56283-2624
Phone
(507) 637-4500
NPI assigned
Dec 16, 2018
Last updated
Sep 14, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2026

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

Authorized official

Name
Michael Blair
Title
Cfo
Phone
(320) 255-5665

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

101 Caring Way
Redwood Falls, MN 56283-2624

Mailing address

PO Box 735826
Chicago, IL 60673-5826
Phone (320) 251-2700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20181129001082 MN Part B Supplier - Clinic/Group Practice 7911259619 Receives reassigned benefits from 182 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Redwood Falls, MN
O20190425000808 MN Part A Provider - Rural Health Clinic 7911259619 Practice locations: Redwood Falls, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396216412. Details of each certification follow.

Rural health clinic certification: CCN 243489

Legal name
CARRIS HEALTH - REDWOOD LLC
Doing business as
CENTRACARE - REDWOOD
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 19, 2019
Last certification
Sep 19, 2019
Ownership / control type
2B
Organization structure
LLCNon-profit
Incorporated
Jan 1, 2019 in MN
Enrollment address
101 Caring Way
Redwood Falls, MN 56283-2624
Related CCNs
241351

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

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

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 18

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Tina SSN May Individual Corporate Director Jul 1, 2025
Michelle Johnson Individual Corporate Director Jul 1, 2021
Thomas Knoblach Individual Corporate Director Jul 1, 2011
Michael a Blair Individual Corporate Officer Sep 30, 2019
W-2 Managing EmployeeCfo Sep 30, 2019
Jeffrey Gau Individual Corporate Director Jul 1, 2017
Renee S Frauendienst Individual Corporate Director Jul 1, 2017
Jacob Lyons Individual Corporate Director Jul 1, 2024
Richard Wehseler Individual Corporate Director Apr 21, 2018
Bobbie Bertram Individual Corporate Director Jul 1, 2015
Kenneth D Holmen Individual Corporate OfficerChain Home Office Admin Jan 1, 2019
Sherri Liebl Individual Corporate DirectorExecutive Director Revenue Cycle Jul 27, 2020
David Anfinson Individual Corporate Director Apr 21, 2018
Carris Health LLC Organization, Willmar, MN LLC, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2019 100%
Daniel Abdul Individual Corporate Director Jul 1, 2022
James Hebl Individual Corporate Director Jul 1, 2017
Carrie Henning-Smith Individual Corporate Director Jul 1, 2023
Centracare Health System Organization, Saint Cloud, MN Non-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2019 100%
Bryan Rolph Individual Corporate Director Jul 1, 2019

Owners & managing parties with NPI records 11

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 28

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 28

Practitioners & affiliated clinicians

Practitioners 95

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 95

NPI Registry JSON

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

{
    "created_epoch": "1544918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789344000000",
    "number": "1396216412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735826",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735826",
            "telephone_number": "320-251-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 CARING WAY",
            "city": "REDWOOD FALLS",
            "state": "MN",
            "postal_code": "562832624",
            "telephone_number": "507-637-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARRIS HEALTH - REDWOOD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-16",
        "last_updated": "2026-09-14",
        "certification_date": "2026-09-14",
        "status": "A",
        "authorized_official_last_name": "BLAIR",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "320-255-5665"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redwood Falls, MN

Sources for this page

Verify at the official NPI Registry.