NPIMap

Organization Active NPI

St. Cloud Ear, Nose & Throat Clinic, P.a.

  • Otolaryngology Physician
  • Saint Cloud, MN
National Provider Identifier
1508882754
Registry record updated Jul 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
ST. CLOUD EAR, NOSE & THROAT CLINIC, P.A.
Practice address
1528 Northway Dr
Saint Cloud, MN 56303-1255
Phone
(320) 252-0233
NPI assigned
Jul 14, 2006
Last updated
Jul 3, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2025

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

Authorized official

Name
Amanda Rae Ressemann
Title
Business Office Manager
Phone
(320) 257-1167

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X NU Primary

Addresses

Primary practice location

1528 Northway Dr
Saint Cloud, MN 56303-1255

Mailing address

1528 Northway Dr
Saint Cloud, MN 56303-1255
Phone (320) 252-0233

Other identifiers 2

IdentifierTypeStateIssuer
55319CLOtherMNBLUE CROSS BLUE SHIELD
508208100MedicaidMN

Other names 1

  • St. Cloud Ear, Nose & Throat - Head & Neck Clinic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051122000206 MN Part B Supplier - Clinic/Group Practice 5496774242 Receives reassigned benefits from 14 practitioners
Practice locations: Alexandria, MN; Little Falls, MN; Saint Cloud, MN; Sauk Centre, MN; Staples, MN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D0405700St Cloud Ear Nose Throat Neck & Head1528 Northway Drive, Saint Cloud, MN 56303Certificate of waiverJan 31, 2028

National Provider Directory

National Provider Directory

Locations

1528 Northway Dr
Saint Cloud, MN 56303
Phone (320) 252-0233

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751500800000",
    "number": "1508882754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1528 NORTHWAY DR",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031255",
            "telephone_number": "320-252-0233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1528 NORTHWAY DR",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031255",
            "telephone_number": "320-252-0233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. CLOUD EAR, NOSE & THROAT CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2025-07-03",
        "certification_date": "2025-07-03",
        "status": "A",
        "authorized_official_last_name": "RESSEMANN",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "RAE",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "320-257-1167"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "55319CL",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "508208100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Cloud Ear, Nose & Throat - Head & Neck Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Saint Cloud, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.