NPIMap

Organization Active NPI

St. Cloud Hospital

  • Rehabilitation Hospital Unit
  • Saint Cloud, MN
National Provider Identifier
1619934627
Registry record updated Oct 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
License
331506 Issued in MN
Legal business name
ST. CLOUD HOSPITAL
Practice address
1406 6TH Ave North
Saint Cloud, MN 56303-1900
Phone
(320) 251-2700
Fax
(320) 656-7009
NPI assigned
Apr 26, 2006
Last updated
Oct 10, 2019By the provider in NPPES
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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X 331506 MN
Rehabilitation Hospital Unit 273Y00000X 331506 MN Primary

Addresses

Primary practice location

1406 6TH Ave North
Saint Cloud, MN 56303-1900

Mailing address

1406 6TH Ave North
Saint Cloud, MN 56303-1900
Phone (320) 251-2700

Other identifiers 2

IdentifierTypeStateIssuer
883747300MedicaidMN
883747301MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100510000680 MN Part A Provider - Hospital 4880594779 Practice locations: Saint Cloud, MN
O20110221000134 MN Part B Supplier - Clinic/Group Practice 4880594779 Receives reassigned benefits from 440 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: St Cloud, MN; Waite Park, MN; Sauk Rapids, MN; Sartell, MN; Saint Cloud, MN; Melrose, MN; Albany, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619934627. Details of each certification follow.

Hospital certification: CCN 24T036

Legal name
ST CLOUD HOSPITAL
Doing business as
CENTRACARE - ST CLOUD HOSPITAL INPATIENT REHABILITATION
Organization structure
CorporationNon-profit
Incorporated
Sep 12, 1962 in MN
Enrollment address
1406 6TH Ave N
Saint Cloud, MN 56303-1900
Hospital Rehabilitation Unit
Hospital subgroups
Rehabilitation

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

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
St Cloud Hospital Inpatient Rehabilitation UnitCCN 24T036 · All quality measures
Ownership
Non-profit
Certified
Jul 1, 1984

National Provider Directory

National Provider Directory
Tax ID family
St Cloud Hosp15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Ownership & related parties

All disclosed owners & managing parties 18

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
Michelle Johnson Individual Corporate Director Jul 1, 2021
Thomas Knoblach Individual Corporate Director Jul 1, 2011
Michael a Blair Individual Corporate OfficerCfo Sep 30, 2019
W-2 Managing EmployeeCfo Sep 30, 2019
Jeffrey Gau Individual Corporate Director Jul 1, 2017
Renee S Frauendienst Individual Corporate DirectorBoard Member Jul 1, 2017
Jacob Lyons Individual Corporate Director Jul 1, 2024
Richard Wehseler Individual Corporate Director Apr 21, 2018
Bobbie Bertram Individual Corporate Director Jul 1, 2015
Kenneth D Holmen Individual Corporate OfficerCeo Jan 1, 2015
Sherri Liebl Individual Corporate OfficerExecutive Director Sep 30, 2019
St Cloud Hospital Organization, Saint Cloud, MN Non-profit Operational/Managerial Control Apr 20, 2015
David Anfinson Individual Corporate Director Apr 21, 2018
Daniel Abdul Individual Corporate Director Jul 1, 2022
James Hebl Individual Corporate Director Jul 1, 2017
Carrie Henning-Smith Individual Corporate Director Jul 1, 2023
Centracare Health System Organization, Saint Cloud, MN Corporation, Non-profit Operational/Managerial Control Jul 3, 1995
Bryan Rolph Individual Corporate Director Jul 1, 2019

Owners & managing parties with NPI records 13

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

View all 13

Facilities with the same owner 28

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 28

Practitioners & affiliated clinicians

Practitioners 69

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 69

Affiliated clinicians 6

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": "1146009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570665600000",
    "number": "1619934627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1406 6TH AVE NORTH",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031900",
            "telephone_number": "320-251-2700",
            "fax_number": "320-656-7009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1406 6TH AVE NORTH",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031900",
            "telephone_number": "320-251-2700",
            "fax_number": "320-656-7009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. CLOUD HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-26",
        "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": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "MN",
            "license": "331506",
            "primary": false
        },
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "MN",
            "license": "331506",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "883747300",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "883747301",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.