NPIMap

Organization Active NPI

Brainerd Lakes Surgery Center L L C

  • Ambulatory Surgical Clinic/Center
  • Baxter, MN
National Provider Identifier
1750378295
Registry record updated Oct 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
328113 Issued in MN
Legal business name
BRAINERD LAKES SURGERY CENTER L L C
Practice address
13114 Isle Dr
Baxter, MN 56425-8330
Phone
(218) 822-2400
Fax
(218) 822-2401
NPI assigned
Sep 30, 2005
Last updated
Oct 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Melissa Schwendeman
Title
Administrator
Phone
(218) 822-2415

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 328113 MN Primary

Addresses

Primary practice location

13114 Isle Dr
Baxter, MN 56425-8330

Mailing address

13114 Isle Dr
Baxter, MN 56425-8330
Phone (218) 822-2400

Other identifiers 9

IdentifierTypeStateIssuer
201937000MedicaidMN
P00205406OtherMNPALMETTO GBA
2314785OtherMNAMERICAS PPO ARAZ
1043422OtherMNPREFERRED ONE
6800051OtherMNSELECT CARE
0L00BROtherMNBCBS
105730OtherMNHEALTHPARTNERS
181112OtherMNUCARE
6800051OtherMNMEDICA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050412001404 MN Part B Supplier - Ambulatory Surgical Center 5395782213 Receives reassigned benefits from 21 practitioners
Practice locations: Baxter, MN

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Brainerd Lakes Surgery Center L L CCCN 24C0001046
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D1053626Brainerd Lakes Surgery Center LLC13114 Isle Drive, Baxter, MN 56425Certificate of waiverApr 29, 2028

National Provider Directory

National Provider Directory

Member of 2

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

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729728000000",
    "number": "1750378295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13114 ISLE DR",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564258330",
            "telephone_number": "218-822-2400",
            "fax_number": "218-822-2401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13114 ISLE DR",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564258330",
            "telephone_number": "218-822-2400",
            "fax_number": "218-822-2401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAINERD LAKES SURGERY CENTER L L C",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-30",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A",
        "authorized_official_last_name": "SCHWENDEMAN",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "218-822-2415"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MN",
            "license": "328113",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201937000",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA",
            "identifier": "P00205406",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAS PPO ARAZ",
            "identifier": "2314785",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1043422",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SELECT CARE",
            "identifier": "6800051",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0L00BR",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "105730",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "181112",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "6800051",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baxter, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.