Centracare Health System - Melrose
Organization Active NPI Critical Access Hospital · Melrose, MN
NPI 1720045073 · NPPES record last updated Oct 10, 2019
Key facts
- NPI
- 1720045073
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- License
- 347139 (MN)
- Legal business name
- CENTRACARE HEALTH SYSTEM - MELROSE
- Practice address
- 525 W. Main Street
Melrose, MN 56352-1071 - Phone
- (320) 256-4231
- Fax
- (320) 256-4949
- NPI assigned
- Apr 28, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Michael A. Blair
- Title
- Sr. Vice President and Cfo
- Phone
- (320) 255-5665
Owners & managing parties with NPI records 7
-
Bobbie Jo Bertram, RN, CNP
-
James Russell Hebl, M.D.
-
Jacob Lyons, MD
-
Bryan P Rolph, MD
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 2
Related certifications (CCN) 2
Facilities with the same owner 28
Practitioners 200
-
Malik Ahmad, M.D.
-
Scott Bertram, RN
-
Michael Jon Beste, M.D.
-
Anjali Dahiya, M D
-
Jacelyn Paige Davidson, M.D.
-
Patrick Joel Heller, M.D.
-
Emily Agnes Jelen, DNP
-
Julie Ann Klasen, M.D.
-
Miranda R Proell, CNP
-
Ramesh Kumar Tentu, MBBS
-
Jennifer Rose Tomford, APRN-FNP
-
Osama Abid, M.D.
-
Jastindeep Brar, MD
-
Kamran Ilyas, MD
-
Palistha Amatya, MD
-
John Patrick Baker, APRN, CNP
Affiliated clinicians 124
-
Eyas Abla, M.D,
-
Ryan Scott Bailey, M.D.
-
Megan Ann Bendix, PA-C
-
Michael Jon Beste, M.D.
-
Courtney Lynn Brever, PA-C
-
Libby M Brever, MD
-
Nathan R Brever, MD
-
Bryan James Brindley, M.D.
-
Damon Marc Campbell, M.D.
-
Monazza Chaudhry, MD
-
Michelle Lea Dahlberg, PA-C
-
Nathan B Danielson, D.O.
-
Jacelyn Paige Davidson, M.D.
-
Ryan R. Davis, D.O.
-
Jenifer Karen Detert, P.A.
-
Sara Dezell, R.N.
-
James Dickinson, M.D.
Medicare Care Compare: Hospital
- Listed as
- Centracare Health System - Melrose Hospital
- Overall star rating
- ★★★★★ 5 of 5
- Type
- Critical Access Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in MN
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
- Corporation · Non-profit
- Enrollment address
- 525 Main St W
Melrose, MN 56352-1043
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| Tina SSN May |
Corporate Director | Jul 1, 2025 | |
| Michelle Johnson |
Corporate Director | Jul 1, 2021 | |
| Thomas Knoblach |
Corporate Director | Jul 1, 2011 | |
| Michael a Blair |
Corporate Officer |
Sep 30, 2019 | |
| W-2 Managing Employee |
Sep 30, 2019 | ||
| Jeffrey Gau |
Corporate Director | Jul 1, 2017 | |
| Renee S Frauendienst |
Corporate Director | Jul 1, 2017 | |
| Jacob Lyons |
Corporate Director | Jul 1, 2024 | |
| Richard Wehseler |
Corporate Director | Apr 21, 2018 | |
| Bobbie Bertram |
Corporate Director | Jul 1, 2015 | |
| Kenneth D Holmen |
Corporate Director |
Jan 1, 2015 | |
| Sherri Liebl |
Corporate Director | Sep 30, 2019 | |
| David Anfinson |
Corporate Director | Apr 21, 2018 | |
| Daniel Abdul |
Corporate Director | Jul 1, 2022 | |
| James Hebl |
Corporate Director | Jul 1, 2017 | |
| Carrie Henning-Smith |
Corporate Director | Jul 1, 2023 | |
| Centracare Health System |
Operational/Managerial Control | Jul 1, 1997 | |
| Bryan Rolph |
Corporate Director | Jul 1, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Access Hospital | 282NC0060X | 330997 | MN | |
| Critical Access Hospital | 282NC0060X | 347139 | MN | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 06374750 | Medicaid | MN |
Other names
- CentraCare Health - Melrose Hospital
Other providers in Melrose, MN
- Tiffany Breitbach
- Amanda Butkowski
- Centracare Clinic Melrose
- Centracare Health Services of Melrose
- Centracare Health System - Melrose
- Centracare Health System - Melrose
- Christian James Chapin
- City of Melrose
- Coborns Inc
- Cura of Melrose LLC
All providers in Melrose, MN · Critical Access Hospital in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 10, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.