NPIMap

Individual provider Active NPI

Shaun Fernandes, MD

  • Internal Medicine Physician
  • Saint Cloud, MN
National Provider Identifier
1548640436
Registry record updated Jan 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
63942 Issued in MN
Practice address
1200 6TH Ave N
Saint Cloud, MN 56303-2735
Phone
(320) 240-2100
Fax
(320) 240-2834
NPI assigned
Jun 4, 2015
Last updated
Jan 31, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2022

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 R-10247 IA
Internal Medicine Physician 207R00000X 63942 MN Primary

Addresses

Primary practice location

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

Mailing address

1200 6TH Ave N
Saint Cloud, MN 56303-2735
Phone (320) 240-2100

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
I20180828000595 MN Practitioner - Internal MedicinePractitioner - Hospitalist 9133432610 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Hospitalist
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centracare Health System-NR LLCGroup PAC ID 3870739410, shared by 4 NPIs, 63 clinicians
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

1013 Hart Blvd
Monticello, MN 55362-8575
Phone (763) 295-2945

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

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
63942MNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic Current Accepting new patients
Centracare Health System-NR LLC CurrentSince Nov 12, 2019 Accepting new patients
Centracare Clinic CurrentSince Aug 6, 2018 Accepting new patients
Centracare Clinic CurrentSince Aug 6, 2018 Accepting new patients
Centracare Health System-NR LLC Current Accepting new patients
St. Cloud Hospital Past Accepting new patients
Centracare Clinic Past Accepting new patients
Centracare Clinic Past Accepting new patients

Locations

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

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

1406 6th Ave N
Saint Cloud, MN 56303
Phone (320) 255-5657

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

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 8

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": "1433376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643587200000",
    "number": "1548640436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 6TH AVE N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032735",
            "telephone_number": "320-240-2100",
            "fax_number": "320-240-2834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 6TH AVE N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032735",
            "telephone_number": "320-240-2100",
            "fax_number": "320-240-2834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERNANDES",
        "first_name": "SHAUN",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-04",
        "last_updated": "2022-01-31",
        "certification_date": "2022-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "R-10247",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "63942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.