NPIMap

Organization Active NPI

St Cloud Hospital

Doing business as CentraCare St Cloud Hospital Adolescent Addiction Services

  • Substance Use Disorder Rehabilitation Hospital Unit
  • Saint Cloud, MN
National Provider Identifier
1811150618
Registry record updated Jun 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Hospital UnitTaxonomy code 276400000X
License
1031225 2 CDT Issued in MN
Legal business name
ST CLOUD HOSPITAL
Doing business as
CentraCare St Cloud Hospital Adolescent Addiction Services
Practice address
1572 County Road 134
Saint Cloud, MN 56303-0346
Phone
(320) 229-4950
NPI assigned
Jul 2, 2008
Last updated
Jun 20, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2023

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 & Cfo
Phone
(320) 255-5665

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Hospital Unit 276400000X 1031225 2 CDT MN Primary

Addresses

Primary practice location

1572 County Road 134
Saint Cloud, MN 56303-0346

Mailing address

1406 6TH Ave N
Saint Cloud, MN 56303-1900
Phone (320) 251-2700

Other names 1

  • CentraCare St Cloud Hospital Adolescent Addiction Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060105000942 MN Part A Provider - Hospital 4880594779 6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sartell, MN; St Cloud, MN; Saint Cloud, MN; Becker, MN
O20110221000134 MN Part B Supplier - Clinic/Group Practice 4880594779 Receives reassigned benefits from 440 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: St Cloud, MN; Waite Park, MN; Sauk Rapids, MN; Sartell, MN; Saint Cloud, MN; Melrose, MN; Albany, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811150618. Details of each certification follow.

Hospital certification: CCN 240036

Legal name
ST CLOUD HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Aug 4, 2011
Beds
489 (469 certified)
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Sep 12, 1962 in MN
Enrollment address
1406 6TH Ave N
Saint Cloud, MN 56303-1900
Main/Primary Hospital Location
Hospital subgroups
Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 11

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Centracare - St. Cloud HospitalCCN 240036 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

1564 County Road 134
Saint Cloud, MN 56303
Phone (320) 229-4950

1900 Centracare Cir
Ste 2400
Saint Cloud, MN 56303
Phone (320) 229-4916

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
Michelle Johnson Individual Corporate Director Jul 1, 2021
Thomas Knoblach Individual Corporate Director Jul 1, 2011
Michael a Blair Individual Corporate OfficerCfo Sep 30, 2019
W-2 Managing EmployeeCfo Sep 30, 2019
Jeffrey Gau Individual Corporate Director Jul 1, 2017
Renee S Frauendienst Individual Corporate DirectorBoard Member Jul 1, 2017
Jacob Lyons Individual Corporate Director Jul 1, 2024
Richard Wehseler Individual Corporate Director Apr 21, 2018
Bobbie Bertram Individual Corporate Director Jul 1, 2011
Kenneth D Holmen Individual Corporate Director Jan 1, 2015
Sherri Liebl Individual Corporate OfficerExecutive Director Sep 30, 2019
David Anfinson Individual Corporate Director Apr 21, 2018
Daniel Abdul Individual Corporate Director Jul 1, 2022
James Hebl Individual Corporate Director Jul 1, 2017
Carrie Henning-Smith Individual Corporate Director Jun 30, 2024
Centracare Health System Organization, St Cloud, MN Operational/Managerial Control Jul 3, 1995
Bryan Rolph Individual Corporate Director 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.

Practitioners & affiliated clinicians

Practitioners 29

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 29

Affiliated clinicians 974

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 974

NPI Registry JSON

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

{
    "created_epoch": "1214956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687219200000",
    "number": "1811150618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1406 6TH AVE N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031900",
            "telephone_number": "320-251-2700",
            "fax_number": "320-656-7009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1572 COUNTY ROAD 134",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563030346",
            "telephone_number": "320-229-4950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST CLOUD HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-02",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "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 & CFO",
        "authorized_official_telephone_number": "320-255-5665",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "276400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation, Substance Use Disorder Unit",
            "state": "MN",
            "license": "1031225 2 CDT",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CentraCare St Cloud Hospital Adolescent Addiction Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.