NPIMap

Organization Active NPI

Centracare Health System - Melrose

Doing business as CentraCare Health - Melrose Hospital

  • Critical Access Hospital
  • Melrose, MN
National Provider Identifier
1720045073
Registry record updated Oct 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
347139 Issued in MN
Legal business name
CENTRACARE HEALTH SYSTEM - MELROSE
Doing business as
CentraCare Health - Melrose Hospital
Practice address
525 W. Main Street
Melrose, MN 56352-1071
Phone
(320) 256-4231
Fax
(320) 256-4949
NPI assigned
Apr 28, 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
Critical Access Hospital 282NC0060X 330997 MN
Critical Access Hospital 282NC0060X 347139 MN Primary

Addresses

Primary practice location

525 W. Main Street
Melrose, MN 56352-1071

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
06374750MedicaidMN

Other names 1

  • CentraCare Health - Melrose Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20031231000690 MN Part B Supplier - Clinic/Group Practice 1658270368 Receives reassigned benefits from 173 practitioners
1 other NPI on this enrollment
Practice locations: Melrose, MN
O20060504000839 MN Part A Provider - Critical Access Hospital 1658270368 Receives reassigned benefits from 157 practitioners
1 other NPI on this enrollment
Practice locations: Melrose, MN
O20200130000070 MN Part B Supplier - Intensive Cardiac Rehabilitation 1658270368 Practice locations: Melrose, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720045073. Details of each certification follow.

Hospital certification: CCN 241330

Legal name
CENTRACARE HEALTH SYSTEM - MELROSE
Doing business as
CENTRACARE - MELROSE HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Apr 1, 2002
Last certification
Jul 17, 2024
Beds
28 (25 certified)
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
525 Main St W
Melrose, MN 56352-1043
Main/Primary Hospital Location

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

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Centracare Health System - Melrose HospitalCCN 241330 · All quality measures
Overall star rating
5 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory

Member of 1

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

Ownership & related parties

All disclosed owners & managing parties 17

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 Director 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 DirectorBoard Member Jan 1, 2015
Sherri Liebl Individual Corporate Director Sep 30, 2019
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 Non-profit Operational/Managerial Control Jul 1, 1997
Bryan Rolph Individual Corporate Director Jul 1, 2019

Owners & managing parties with NPI records 7

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

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 185

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 185

Affiliated clinicians 124

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 124

NPI Registry JSON

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

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570665600000",
    "number": "1720045073",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 W. MAIN STREET",
            "city": "MELROSE",
            "state": "MN",
            "postal_code": "563521071",
            "telephone_number": "320-256-4231",
            "fax_number": "320-256-4949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRACARE HEALTH SYSTEM - MELROSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-28",
        "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": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MN",
            "license": "330997",
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MN",
            "license": "347139",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06374750",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CentraCare Health - Melrose Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Melrose, MN

Sources for this page

Verify at the official NPI Registry.