NPIMap

St Joseph'S Medical Center

Organization Active NPI Radiology Clinic/Center · Brainerd, MN

NPI 1639648348 · NPPES record last updated Feb 27, 2024

Key facts

NPI
1639648348
Entity type
Organization (NPI type 2)
Primary specialty
Radiology Clinic/Center 261QR0200X
Legal business name
ST JOSEPH'S MEDICAL CENTER
Practice address
2019 S 6TH St
Brainerd, MN 56401-4528
Phone
(218) 822-6736
Fax
(218) 822-3758
NPI assigned
Nov 26, 2018
Organization subpart
Yes
Parent organization (as reported)
ESSENTIA HEALTH

Authorized official

Name
Kevin Boren
Title
VP of Finance
Phone
(218) 786-1009

Other NPIs with the same Medicare PAC ID 1

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

Corporate family (same tax ID) 11

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

Practitioners 239

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 239

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MN

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20190312001814 MN Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 8224948443 Practice locations: Brainerd, MN

National Provider Directory

Tax ID family
St Josephs Medical Ctr (12 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X Yes

Addresses

Primary practice location

2019 S 6TH St
Brainerd, MN 56401-4528

Mailing address

2019 S 6TH St
Brainerd, MN 56401-4528
Phone (218) 822-6736

Other names

  • Essentia Health Lakes Imaging Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 27, 2024.

{
    "created_epoch": "1543190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708992000000",
    "number": "1639648348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2019 S 6TH ST",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564014528",
            "telephone_number": "218-822-6736",
            "fax_number": "218-822-3758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2019 S 6TH ST",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564014528",
            "telephone_number": "218-822-6736",
            "fax_number": "218-822-3758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOSEPH'S MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESSENTIA HEALTH",
        "enumeration_date": "2018-11-26",
        "last_updated": "2024-02-27",
        "certification_date": "2024-02-27",
        "status": "A",
        "authorized_official_last_name": "BOREN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "218-786-1009"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Lakes Imaging",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Essentia Health Lakes Imaging",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brainerd, MN

All providers in Brainerd, MN · Radiology Clinic/Center in Minnesota

Sources for this page

Verify at the official NPI Registry.