NPIMap

Organization Active NPI

Central Minnesota Mental Health Center

  • Addiction (Substance Use Disorder) Counselor
  • Buffalo, MN
National Provider Identifier
1679694616
Registry record updated Jul 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
807286-5-CDT Issued in MN
Legal business name
CENTRAL MINNESOTA MENTAL HEALTH CENTER
Practice address
308 12TH Ave S
Buffalo, MN 55313-2321
Phone
(763) 682-4400
Fax
(763) 682-1353
NPI assigned
Apr 3, 2007
Last updated
Jul 21, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2008

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

Authorized official

Name
David Baraga, PH.D, LPNPI 1679519789
Title
Executive Director
Phone
(320) 252-5010

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 807286-5-CDT MN Primary

Addresses

Primary practice location

308 12TH Ave S
Buffalo, MN 55313-2321

Mailing address

1321 13TH St N
Saint Cloud, MN 56303-2613
Phone (320) 252-5010

Other identifiers 1

IdentifierTypeStateIssuer
492319700OtherMNPROVIDER NUMBERE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040119000248 MN Part B Supplier - Clinic/Group Practice 4486555877 Receives reassigned benefits from 47 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Monticello, MN; Waite Park, MN; Saint Cloud, MN; Elk River, MN; Buffalo, MN

Other NPIs on the same Medicare enrollment 12

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

National Provider Directory

National Provider Directory

Locations

308 12th Ave S
Buffalo, MN 55313
Phone (763) 682-4400

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216598400000",
    "number": "1679694616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1321 13TH ST N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032613",
            "telephone_number": "320-252-5010",
            "fax_number": "320-203-1855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 12TH AVE S",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "553132321",
            "telephone_number": "763-682-4400",
            "fax_number": "763-682-1353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL MINNESOTA MENTAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2008-07-21",
        "status": "A",
        "authorized_official_last_name": "BARAGA",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "320-252-5010",
        "authorized_official_credential": "PH.D, LP"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "807286-5-CDT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NUMBERE",
            "identifier": "492319700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.