NPIMap

Organization Active NPI

Centracare Health System - Melrose

Doing business as CentraCare Health - Melrose Clinic

  • Rural Health Clinic/Center
  • Melrose, MN
National Provider Identifier
1730407586
Registry record updated Oct 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CENTRACARE HEALTH SYSTEM - MELROSE
Doing business as
CentraCare Health - Melrose Clinic
Practice address
525 W Main St
Melrose, MN 56352-1043
Phone
(320) 256-4231
Fax
(320) 256-4949
NPI assigned
May 4, 2010
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
Multi-Specialty Clinic/Center 261QM1300X NU
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

525 W Main St
Melrose, MN 56352-1043

Mailing address

1200 6TH Ave N
Saint Cloud, MN 56303-2735
Phone (320) 256-4231

Other names 1

  • CentraCare Health - Melrose Clinic 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
This NPI is an additional NPI on the 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
This NPI is an additional NPI on the enrollment
Practice locations: Melrose, MN
O20110505000864 MN Part A Provider - Rural Health Clinic 1658270368 1 other NPI on this enrollment
Practice locations: Melrose, MN

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1730407586. 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

Rural health clinic certification: CCN 243454

Legal name
CENTRACARE HEALTH SYSTEM - MELROSE
Doing business as
CENTRACARE - MELROSE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 19, 2011
Last certification
Jul 17, 2018
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1997 in MN
Enrollment address
525 Main St W
Melrose, MN 56352-1043
Related CCNs
241330

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
Corporate DirectorBoard Member Jul 1, 2025
Michelle Johnson Individual Corporate Director Jul 1, 2021
Corporate DirectorBoard Member Jul 1, 2021
Thomas Knoblach Individual Corporate Director Jul 1, 2011
Corporate DirectorBoard Member Jul 1, 2020
Michael a Blair Individual Corporate OfficerCfo Sep 30, 2019
W-2 Managing EmployeeCfo Sep 30, 2019
Jeffrey Gau Individual Corporate Director Jul 1, 2017
Corporate DirectorBoard Member 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
Corporate DirectorBoard Member Apr 21, 2018
Bobbie Bertram Individual Corporate Director Jul 1, 2015
Corporate DirectorBoard Member Jul 1, 2021
Kenneth D Holmen Individual Corporate DirectorBoard Member Jan 1, 2015
Operational/Managerial ControlCeo, Centracare Health System Jan 1, 2015
Sherri Liebl Individual Corporate Director Sep 30, 2019
Corporate OfficerExecutive Director Sep 30, 2019
David Anfinson Individual Corporate Director Apr 21, 2018
Corporate DirectorBoard Member Apr 21, 2018
Daniel Abdul Individual Corporate Director Jul 1, 2022
James Hebl Individual Corporate Director Jul 1, 2017
Corporate DirectorBoard Member 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
Operational/Managerial Control Mar 1, 1997
Bryan Rolph Individual Corporate Director Jul 1, 2019
Corporate DirectorBoard Member 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 94

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 94

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": "1272931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570665600000",
    "number": "1730407586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 6TH AVE N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032735",
            "telephone_number": "320-256-4231",
            "fax_number": "320-256-4949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 W MAIN ST",
            "city": "MELROSE",
            "state": "MN",
            "postal_code": "563521043",
            "telephone_number": "320-256-4231",
            "fax_number": "320-256-4949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRACARE HEALTH SYSTEM - MELROSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-04",
        "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": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CentraCare Health - Melrose Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Melrose, MN

Sources for this page

Verify at the official NPI Registry.