NPIMap

Individual provider Active NPI

Samantha J Ganick, M.D.

  • Urology Physician
  • Sartell, MN
National Provider Identifier
1447420427
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
253902 Issued in MA
Practice address
2351 Connecticut Ave S Ste 200
Sartell, MN 56377-2477
Phone
(320) 259-1411
Fax
(320) 259-8967
NPI assigned
Mar 6, 2008
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 253902 MA Primary

Addresses

Primary practice location

2351 Connecticut Ave S Ste 200
Sartell, MN 56377-2477

Mailing address

2351 Connecticut Ave S Ste 200
Sartell, MN 56377-2477
Phone (320) 259-1411

Other practice location 1

31 Village Sq
Chelmsford, MA 01824-2712
Phone (978) 256-9507

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
I20170921002773 MN Practitioner - Urology 2163695735 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Oklahoma College of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Centracare Clinic Southwest LLCGroup PAC ID 8426457946, 172 clinicians
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

101 Willmar Ave SW
Willmar, MN 56201-3556
Phone (320) 231-5000

2351 Connecticut Ave S
Suite 200
Sartell, MN 56377-2477
Phone (320) 259-1411

600 Peterson Pkwy
New London, MN 56273-7823
Phone (320) 354-2222

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection29

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic Current Accepting new patients
Centracare Clinic Southwest LLC CurrentSince Nov 1, 2021 Accepting new patients
Centracare Clinic CurrentSince Oct 2, 2017 Accepting new patients
Centracare Clinic Southwest LLC CurrentSince Nov 1, 2021 Accepting new patients
Centracare Clinic CurrentSince Oct 2, 2017 Accepting new patients
LGH Medical Group, Inc. PastSince Apr 30, 2013 Accepting new patients
Centracare Clinic Past Accepting new patients
William F. Barnes, MD, PC PastSince Jan 1, 2006 Accepting new patients

Locations

600 Peterson Pkwy
New London, MN 56273
Phone (320) 354-2222

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

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

2351 Connecticut Ave S
Ste 200
Sartell, MN 56377
Phone (320) 203-6906

101 Willmar Ave SW
Willmar, MN 56201
Phone (320) 231-5079

Interoperability endpoints

  • Direct secure messaging: sganick371560@direct.centracare.com

Organizations & group practices 8

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 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": "1204761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1447420427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2351 CONNECTICUT AVE S STE 200",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563772477",
            "telephone_number": "320-259-1411",
            "fax_number": "320-259-8967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2351 CONNECTICUT AVE S STE 200",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563772477",
            "telephone_number": "320-259-1411",
            "fax_number": "320-259-8967"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "31 Village Sq",
            "address_purpose": "LOCATION",
            "city": "Chelmsford",
            "state": "MA",
            "postal_code": "018242712",
            "country_code": "US",
            "telephone_number": "978-256-9507",
            "fax_number": "978-244-1219",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GANICK",
        "first_name": "SAMANTHA",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-06",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MA",
            "license": "253902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sartell, MN

Sources for this page

Verify at the official NPI Registry.