Carris Health - Redwood LLC
Organization Active NPI Rural Health Clinic/Center · Redwood Falls, MN
NPI 1396216412 · NPPES record last updated Sep 26, 2024
Key facts
- NPI
- 1396216412
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 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
- Organization subpart
- No
Authorized official
- Name
- Michael Blair
- Title
- Cfo
- Phone
- (320) 255-5665
Owners & managing parties with NPI records 11
-
Bobbie Jo Bertram, RN, CNP
-
James Russell Hebl, M.D.
-
Jacob Lyons, MD
-
Bryan P Rolph, MD
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 5
Member of 2
Related certifications (CCN) 1
Facilities with the same owner 28
Practitioners 122
-
Melody Adams, PA-C
-
Kristen Anne Altermatt, RN, CNP
-
Heather Bidinger, PA
-
Thomas A Bruns, CRNA
-
Anjali Dahiya, M D
-
Alicia Eliason, RN, CNP
-
Sarah Elizabeth Lechner, NP-C
-
Jastindeep Brar, MD
-
Malik Ahmad, M.D.
-
Marley Braun, CNP
-
Amy Jo Buffington, NP-C
-
Matthew Eggebrecht, M.D.
-
Jennifer L Flinn, PSYD, LP
-
Joshua D. Friese, MD
-
Jill Marie Jay, FNP
-
Sriveer Kaasam, M.D.
-
Kelly Marie Kerber, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
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
- LLC · Non-profit
- Incorporated
- Jan 1, 2019 in MN
- Enrollment address
- 101 Caring Way
Redwood Falls, MN 56283-2624 - Related CCNs
- 241351
All disclosed owners & managing parties 18
| 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 Officer |
Jan 1, 2019 | |
| Sherri Liebl |
Corporate Director |
Jul 27, 2020 | |
| David Anfinson |
Corporate Director | Apr 21, 2018 | |
| Carris Health LLC |
5% Or Greater Direct Ownership Interest | Jan 1, 2019 | 100% |
| 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 Indirect Ownership Interest | Jan 1, 2019 | 100% |
| Bryan Rolph |
Corporate Director | Jul 1, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
101 Caring Way
Redwood Falls, MN 56283-2624
Mailing address
1200 6TH Ave N
Saint Cloud, MN 56303-2735
Phone (320) 251-2700
Other providers in Redwood Falls, MN
- Carris Health - Redwood LLC
- Carris Health - Redwood LLC
- Carris Health - Redwood LLC
- Carris Health - Redwood LLC
- Carris Health - Redwood LLC
- Carris Health LLC
- Centracare Medical Supply LLC
- Chiro-Plus, P.a.
- Choices Behavioral Health L.L.C.
- Michelle R Cilek
All providers in Redwood Falls, MN · Rural Health Clinic/Center in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 26, 2024. 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.