NPIMap

Organization Active NPI

Centracare Health-Paynesville LLC

  • Medicare Defined Swing Bed Hospital Unit
  • Paynesville, MN
National Provider Identifier
1457786972
Registry record updated Oct 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
CENTRACARE HEALTH-PAYNESVILLE LLC
Practice address
200 W 1St St
Paynesville, MN 56362-1445
Phone
(320) 243-3767
Fax
(320) 243-7955
NPI assigned
Sep 4, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2019

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

Authorized official

Name
Mr. Michael A. Blair
Title
Sr. Vice President and Cfo
Phone
(320) 255-5665

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X Primary

Addresses

Primary practice location

200 W 1St St
Paynesville, MN 56362-1445

Mailing address

200 W 1St St
Paynesville, MN 56362-1445
Phone (320) 243-3767

Other names 1

  • CentraCare Health - Paynesville Swingbed Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131018000577 MN Part A Provider - Critical Access Hospital 1153555719 Practice locations: Paynesville, MN

Hospital certification: CCN 24Z349

Legal name
CENTRACARE HEALTH-PAYNESVILLE LLC
Doing business as
CENTRACARE - PAYNESVILLE SWING BED
Organization structure
LLCNon-profit
Incorporated
Jul 30, 2013 in MN
Enrollment address
200 W 1St St
Paynesville, MN 56362-1445

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

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
700 Stearns Place3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

300 Hwy 23 Ste 4
Ste 4
Spicer, MN 56288
Phone (320) 796-2103

Ownership & related parties

All disclosed owners & managing parties 17

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
Centracare Health-Paynesville LLC Organization, Saint Cloud, MN LLC, Non-profit Operational/Managerial Control Jun 20, 2014
Michelle Johnson Individual Corporate DirectorBoard Member Jul 1, 2021
Thomas Knoblach Individual Corporate DirectorBoard Member Jul 1, 2020
Michael a Blair Individual Corporate OfficerCfo Sep 30, 2019
W-2 Managing Employee Sep 30, 2019
Jeffrey Gau Individual Corporate DirectorBoard Member Jul 1, 2017
Renee S Frauendienst Individual Corporate Director Jul 1, 2017
Jacob Lyons Individual Corporate Director Jul 1, 2024
Richard Wehseler Individual Corporate DirectorBoard Member Apr 21, 2018
Bobbie Bertram Individual Corporate DirectorBoard Member Jul 1, 2021
Kenneth D Holmen Individual Corporate DirectorBoard Member Jan 1, 2015
Sherri Liebl Individual Corporate OfficerExecutive Director Sep 30, 2019
David Anfinson Individual Corporate DirectorBoard Member Apr 21, 2018
Daniel Abdul Individual Corporate Director Jul 1, 2022
James Hebl Individual Corporate DirectorBoard Member Jul 1, 2017
Carrie Henning-Smith Individual Corporate Director Jul 1, 2023
Bryan Rolph Individual Corporate DirectorBoard Member Jul 1, 2019

Owners & managing parties with NPI records 8

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

Practitioners & affiliated clinicians

Practitioners 67

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 67

Affiliated clinicians 7

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1378252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570665600000",
    "number": "1457786972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W 1ST ST",
            "city": "PAYNESVILLE",
            "state": "MN",
            "postal_code": "563621445",
            "telephone_number": "320-243-3767",
            "fax_number": "320-243-7955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W 1ST ST",
            "city": "PAYNESVILLE",
            "state": "MN",
            "postal_code": "563621445",
            "telephone_number": "320-243-3767",
            "fax_number": "320-243-7955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRACARE HEALTH-PAYNESVILLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-04",
        "last_updated": "2019-10-10",
        "status": "A",
        "authorized_official_last_name": "BLAIR",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "SR. VICE PRESIDENT AND CFO",
        "authorized_official_telephone_number": "320-255-5665",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CentraCare Health - Paynesville Swingbed",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CentraCare Health - Paynesville Swingbed",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Paynesville, MN

Sources for this page

Verify at the official NPI Registry.