NPIMap

Organization Active NPI

Centracare Health-Paynesville LLC

Doing business as CentraCare Health Paynesville - Eden Valley Clinic

  • Clinic/Center
  • Eden Valley, MN
National Provider Identifier
1700219383
Registry record updated Oct 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
CENTRACARE HEALTH-PAYNESVILLE LLC
Doing business as
CentraCare Health Paynesville - Eden Valley Clinic
Practice address
405 Meeker Ave E
Eden Valley, MN 55329-1629
Phone
(320) 453-2260
Fax
(320) 453-2270
NPI assigned
Aug 19, 2013
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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

405 Meeker Ave E
Eden Valley, MN 55329-1629

Mailing address

200 W 1St St
Paynesville, MN 56362-1445
Phone (320) 243-3767

Other names 1

  • CentraCare Health Paynesville - Eden Valley Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140909002390 MN Part B Supplier - Clinic/Group Practice 1153555719 Receives reassigned benefits from 130 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Watkins, MN; Saint Cloud, MN; Richmond, MN; Cold Spring, MN; Paynesville, MN

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 26

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 26

NPI Registry JSON

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

{
    "created_epoch": "1376870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570665600000",
    "number": "1700219383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W 1ST ST",
            "city": "PAYNESVILLE",
            "state": "MN",
            "postal_code": "563621445",
            "telephone_number": "320-243-3767",
            "fax_number": "320-243-7955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 MEEKER AVE E",
            "city": "EDEN VALLEY",
            "state": "MN",
            "postal_code": "553291629",
            "telephone_number": "320-453-2260",
            "fax_number": "320-453-2270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRACARE HEALTH-PAYNESVILLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-19",
        "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": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CentraCare Health Paynesville - Eden Valley Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CentraCare Health Paynesville - Eden Valley Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eden Valley, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2019; 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.