Stacia S Anderson, MD
Individual provider Active NPI Obstetrics & Gynecology Physician · Saint Cloud, MN
NPI 1720079981 · NPPES record last updated Nov 22, 2011
Key facts
- NPI
- 1720079981
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 44297 (MN)
- Practice address
- 1900 Centracare Cir
Saint Cloud, MN 56303-5000 - Phone
- (320) 654-3630
- Fax
- (320) 654-3657
- NPI assigned
- Nov 4, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 16
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Obstetrics/Gynecology
- Education
- University of Minnesota Medical School, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Centracare Clinic
Practice addresses (Care Compare)
1200 6TH Ave N
Centracare Clic River Campus
Saint Cloud, MN 56303-2735
Phone (320) 252-5131
Hospital & facility affiliations
- Centracare - St. Cloud Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100227000081 | MN | Practitioner - Obstetrics/Gynecology | 2860537032 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 44297 | MN | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Centracare Clinic | Current |
Accepting new patients | |
| Centracare Clinic | Current | Accepting new patients | |
| St. Cloud Hospital | Past | Accepting new patients | |
| Centracare Clinic | Past | Accepting new patients | |
| Centracare Clinic | Past | Accepting new patients |
Locations
1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342
1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422
Interoperability endpoints
- sanderson1172@direct.centracare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 44297 | MN | Yes |
Addresses
Primary practice location
1900 Centracare Cir
Saint Cloud, MN 56303-5000
Mailing address
1900 Centracare Cir
Saint Cloud, MN 56303-5000
Phone (320) 654-3630
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1030414 | Other | PREFERRED ONE | |
| 1855107 | Other | FIRST HEALTH PLAN | |
| 55G63AN | Other | BLUE CROSS BLUE SHIELD | |
| COMP | Other | MMSI | |
| 1545844 | Other | ARAZ GROUP AMERICAS PPO | |
| C11369 | Other | RR MEDICARE | |
| COMP | Other | ONE HEALTH PLAN GREAT WES | |
| 0702359 | Other | MEDICA HEALTH PLANS | |
| 160056138 | Other | RR MEDICARE | |
| 052720300 | Other | MEDICAL ASSISTANCE MA | |
| HP34883 | Other | HEALTH PARTNERS | |
| COMP | Other | CHAMPUS | |
| 141335 | Other | U CARE |
Other providers in Saint Cloud, MN
- Matthew Anderson
- Matthew Paul Anderson
- Paula Anderson
- Shannon Patricia Anderson
- Shereen Lynn Anderson
- Suzanne Gene Anderson
- Thomas Anderson
- Sandra Lee Andreasen
- Mary Helen Andreotti
- Hannah Mary-Lynn Andrews
All providers in Saint Cloud, MN · Obstetrics & Gynecology Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 22, 2011. 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.
- Order and Referring (CMS).
- 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.