NPIMap

Individual provider Active NPI

Walter Lo Sia Su, MD

  • Hospitalist Physician
  • Saint Cloud, MN
National Provider Identifier
1477542371
Registry record updated Dec 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
37684 Issued in MN
Practice address
1200 6TH Ave N
Centra Care Clinic
St Cloud, MN 56303-2735
Phone
(320) 251-2700
Fax
(320) 240-2118
NPI assigned
Oct 14, 2005
Last updated
Dec 21, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 37684 MN
Hospitalist Physician 208M00000X 37684 MN Primary

Addresses

Primary practice location

1200 6TH Ave N
Centra Care Clinic
St Cloud, MN 56303-2735

Mailing address

1200 6TH Ave N
Centra Care Clinic
St Cloud, MN 56303-2735
Phone (320) 251-2700

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
I20050408000871 MN Practitioner - Internal MedicinePractitioner - Hospitalist 2466499744 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Hospitalist
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

1200 6TH Ave N
Saint Cloud, MN 56303-2735

1200 6TH N Ave
Saint Cloud, MN 56303-2735
Phone (320) 252-5131

1406 6TH Ave N
St Cloud, MN 56303-1901

1406 6TH Ave No
St Cloud, MN 56303-1901

1900 Centracare Cir
Saint Cloud, MN 56303-5000

PO Box
Chicago, IL 60673

Hospital & facility affiliations

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 Health System - Long Prairie CurrentSince Nov 1, 2023 Accepting new patients
Carris Health - Redwood LLC Current Accepting new patients
Carris Health - Redwood LLC Current Accepting new patients
Centracare Health System-NR LLC CurrentSince Mar 4, 2020 Accepting new patients
Centracare Clinic CurrentSince Jun 30, 2005 Accepting new patients
Carris Health - Redwood LLC CurrentSince Feb 1, 2024 Accepting new patients
Carris Health - Redwood LLC CurrentSince Feb 1, 2024 Accepting new patients
Redwood Area Hospital Current Accepting new patients
Centracare Health System-NR LLC Current Accepting new patients
Centracare Health System-NR LLC CurrentSince Mar 4, 2020 Accepting new patients
Centracare Clinic CurrentSince Jun 30, 2005 Accepting new patients
St. Cloud Hospital Past Accepting new patients

Locations

111 17th Ave E
Alexandria, MN 56308
Phone (320) 762-1511

1527 Broadway St
Alexandria, MN 56308
Phone (320) 762-0399

50 Centracare Dr
Long Prairie, MN 56347
Phone (320) 732-2131

1013 Hart Blvd
Monticello, MN 55362
Phone (763) 271-2303

101 Caring Way
Redwood Falls, MN 56283
Phone (507) 637-2911

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

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

Interoperability endpoints

  • Direct secure messaging: wsiasu1573@direct.centracare.com

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 17

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1129248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450656000000",
    "number": "1477542371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 6TH AVE N",
            "address_2": "CENTRA CARE CLINIC",
            "city": "ST CLOUD",
            "state": "MN",
            "postal_code": "563032735",
            "telephone_number": "320-251-2700",
            "fax_number": "320-240-2118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 6TH AVE N",
            "address_2": "CENTRA CARE CLINIC",
            "city": "ST CLOUD",
            "state": "MN",
            "postal_code": "563032735",
            "telephone_number": "320-251-2700",
            "fax_number": "320-240-2118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIA SU",
        "first_name": "WALTER",
        "middle_name": "LO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-14",
        "last_updated": "2015-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "37684",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MN",
            "license": "37684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.