NPIMap

Individual provider Active NPI

Jennifer Boelter, M.D.

  • Family Medicine Physician
  • Saint Cloud, MN
National Provider Identifier
1487684098
Registry record updated Nov 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
41579 Issued in MN
Practice address
251 County Rd 120
Saint Cloud, MN 56303-4665
Phone
(320) 202-8949
Fax
(320) 202-0756
NPI assigned
Jul 3, 2006
Last updated
Nov 23, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 41579 MN Primary

Addresses

Primary practice location

251 County Rd 120
Saint Cloud, MN 56303-4665

Mailing address

251 County Rd 120
Saint Cloud, MN 56303-4665
Phone (320) 202-8949

Other identifiers 1

IdentifierTypeStateIssuer
841595100MedicaidMN

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
I20040624001436 MN Practitioner - Family Practice 3779569496 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
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

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
41579MNMDFamily Medicine Physician

Practice roles

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

251 County Road 120
Sartell, MN 56303
Phone (320) 202-8949

Interoperability endpoints

  • Direct secure messaging: jboelter1206@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": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290470400000",
    "number": "1487684098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "251 COUNTY RD 120",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563034665",
            "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 RD 120",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563034665",
            "telephone_number": "320-202-8949",
            "fax_number": "320-202-0756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOELTER",
        "first_name": "JENNIFER",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-03",
        "last_updated": "2010-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "41579",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "841595100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.