NPIMap

Organization Active NPI

Brainerd Medical Center Inc

Doing business as Essentia Health Baxter Pharmacy

  • Community/Retail Pharmacy
  • Baxter, MN
National Provider Identifier
1841576261
Registry record updated Apr 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
263792 Issued in MN
Legal business name
BRAINERD MEDICAL CENTER INC
Doing business as
Essentia Health Baxter Pharmacy
Practice address
13060 Isle Dr
Baxter, MN 56425-8331
Phone
(218) 454-5920
Fax
(218) 454-5921
NPI assigned
Oct 31, 2011
Last updated
Apr 18, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2017

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

Authorized official

Name
Tim Cernohous, PHARM.D., PH.D.
Title
Director of Ambulatory Pharmacy
Phone
(218) 786-8516

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 263792 MN Primary

Addresses

Primary practice location

13060 Isle Dr
Baxter, MN 56425-8331

Mailing address

13060 Isle Dr
Baxter, MN 56425-8331
Phone (218) 454-5920

Other identifiers 2

IdentifierTypeStateIssuer
2132596OtherPK
1841576261MedicaidMN

Other names 1

  • Essentia Health Baxter Pharmacy Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120810000766 MN DME Supplier - Pharmacy 0648270272 Practice locations: Baxter, MN
O20171013000866 MN Part B Supplier - Mass Immunization (Roster Biller Only) 0648270272 6 other NPIs on this enrollment
Practice locations: Baxter, MN; Brainerd, MN; Deerwood, MN; Pequot Lakes, MN; Pine River, MN; Staples, MN

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 6

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

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Essentia Health Baxter Pharmacy13060 Isle Dr, Baxter, MN 56425-8331(218) 454-5920 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) Accepts assignmentParticipating since Jan 2, 2007

National Provider Directory

National Provider Directory
Tax ID family
Brainerd Medical Center Inc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1320019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492473600000",
    "number": "1841576261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13060 ISLE DR",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564258331",
            "telephone_number": "218-454-5920",
            "fax_number": "218-454-5921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13060 ISLE DR",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564258331",
            "telephone_number": "218-454-5920",
            "fax_number": "218-454-5921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAINERD MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-31",
        "last_updated": "2017-04-18",
        "status": "A",
        "authorized_official_last_name": "CERNOHOUS",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "DIRECTOR OF AMBULATORY PHARMACY",
        "authorized_official_telephone_number": "218-786-8516",
        "authorized_official_credential": "PHARM.D., PH.D."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "263792",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2132596",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1841576261",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Baxter Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Apr 18, 2017; 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.