NPIMap

Organization Active NPI

Centracare Clinic

  • Medical Specialty Clinic/Center
  • Saint Cloud, MN
National Provider Identifier
1790201739
Registry record updated Nov 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
Legal business name
CENTRACARE CLINIC
Practice address
1200 6TH Ave N
Saint Cloud, MN 56303-2735
Phone
(320) 252-5131
Fax
(320) 240-2118
NPI assigned
Aug 22, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2020

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

Authorized official

Name
Michael A Blair
Title
Sr VP & Cfo
Phone
(320) 255-5665

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X Primary

Addresses

Primary practice location

1200 6TH Ave N
Saint Cloud, MN 56303-2735

Mailing address

1200 6TH Ave N
Saint Cloud, MN 56303-2735
Phone (320) 252-5131

Other practice location 1

3701 12th St N Ste 202
Saint Cloud, MN 56303-2253
Phone (320) 258-3090

Other names 1

  • CentraCare Clinic Anesthesiology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031105000293 MN Part B Supplier - Clinic/Group Practice 2466363395 Receives reassigned benefits from 1,127 practitioners
29 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 26

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

View all 26

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 51

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 51

NPI Registry JSON

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

{
    "created_epoch": "1503360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605744000000",
    "number": "1790201739",
    "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": "320-252-5131",
            "fax_number": "320-240-2118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 6TH AVE N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032735",
            "telephone_number": "320-252-5131",
            "fax_number": "320-240-2118"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3701 12th St N Ste 202",
            "address_purpose": "LOCATION",
            "city": "Saint Cloud",
            "state": "MN",
            "postal_code": "563032253",
            "country_code": "US",
            "telephone_number": "320-258-3090",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CENTRACARE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-22",
        "last_updated": "2020-11-19",
        "certification_date": "2020-11-19",
        "status": "A",
        "authorized_official_last_name": "BLAIR",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "SR VP & CFO",
        "authorized_official_telephone_number": "320-255-5665"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CentraCare Clinic Anesthesiology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Cloud, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.