NPIMap

Organization Active NPI

St. Cloud Hospital

Doing business as St Cloud Hospital Outpatient Rehabilitation - South

  • Physical Therapy Clinic/Center
  • Saint Cloud, MN
National Provider Identifier
1679088157
Registry record updated Oct 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
ST. CLOUD HOSPITAL
Doing business as
St Cloud Hospital Outpatient Rehabilitation - South
Practice address
1301 33Rd St S Ste 210
Saint Cloud, MN 56301-9668
Phone
(320) 251-2700
Fax
(320) 656-7009
NPI assigned
Dec 6, 2017
Last updated
Oct 8, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 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 & Cfo
Phone
(320) 255-5665

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

1301 33Rd St S Ste 210
Saint Cloud, MN 56301-9668

Mailing address

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

Other names 1

  • St Cloud Hospital Outpatient Rehabilitation - South Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180221002778 MN Part B Supplier - Hospital Department(S) 4880594779 Receives reassigned benefits from 15 practitioners
Practice locations: Saint Cloud, MN

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
St Cloud Hospital15 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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1301 33rd St S
Ste 210
Saint Cloud, MN 56301
Phone (320) 240-6955

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Centracare - St Cloud Hospital Inpatient RehabilitationSaint Cloud, MN, CCN 24T036 Hospital Operational/Managerial Control Apr 20, 2015

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1512518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570492800000",
    "number": "1679088157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1406 6TH AVE N",
            "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": "1301 33RD ST S STE 210",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563019668",
            "telephone_number": "320-251-2700",
            "fax_number": "320-656-7009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. CLOUD HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-06",
        "last_updated": "2019-10-08",
        "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 & CFO",
        "authorized_official_telephone_number": "320-255-5665",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Cloud Hospital Outpatient Rehabilitation - South",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St Cloud Hospital Outpatient Rehabilitation - South",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.