NPIMap

Individual provider Active NPI

Sara Boleyn, N.P.

  • Women's Health Nurse Practitioner
  • Saint Cloud, MN
National Provider Identifier
1396773537
Registry record updated Feb 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
R1365870 Issued in MN
Practice address
251 County Road 120
Saint Cloud, MN 56303-4872
Phone
(320) 202-8949
Fax
(320) 202-0756
NPI assigned
Jun 28, 2006
Last updated
Feb 17, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X R1365870 MN Primary

Addresses

Primary practice location

251 County Road 120
Saint Cloud, MN 56303-4872

Mailing address

251 County Road 120
Saint Cloud, MN 56303-4872
Phone (320) 202-8949

Other identifiers 1

IdentifierTypeStateIssuer
701104100MedicaidMN

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
I20060908000039 MN Practitioner - Nurse Practitioner 6608870530 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

2000 23Rd St S
Sartell, MN 56377-4765
Phone (320) 202-8949

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic CurrentSince Oct 11, 2017 Accepting new patients
Centracare Clinic Current Accepting new patients
Centracare Clinic CurrentSince Oct 11, 2017 Accepting new patients
Centracare Clinic Past Accepting new patients
Centracare Clinic Past Accepting new patients

Locations

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

1301 33rd St S
Saint Cloud, MN 56301
Phone (320) 240-6955

1301 W Saint Germain St
Saint Cloud, MN 56301
Phone (320) 251-8181

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

Interoperability endpoints

  • Direct secure messaging: sboleyn32991@direct.centracare.com

Organizations & group practices 5

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.

Hospital & facility affiliations 7

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": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455667200000",
    "number": "1396773537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "251 COUNTY ROAD 120",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563034872",
            "telephone_number": "320-202-8949",
            "fax_number": "320-202-0756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "251 COUNTY ROAD 120",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563034872",
            "telephone_number": "320-202-8949",
            "fax_number": "320-202-0756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLEYN",
        "first_name": "SARA",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-28",
        "last_updated": "2016-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "MN",
            "license": "R1365870",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "701104100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.