Centracare Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

CENTRACARE SURGERY CENTER, LLC

Practice address

1900 Centracare Cir
Saint Cloud, MN 56303-5000

Phone

(320) 229-4964

Fax

(320) 229-5171

NPI assigned

Jan 29, 2007

Last updated

Jan 26, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael Blair

Title

Cfo

Phone

(320) 255-5665

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Centracare Surgery Center

  dba Midsota Surgical Suites

  • Ambulatory Surgical Clinic/Center
  • Saint Cloud, MN
  • NPI 1194271239

  O20070406000176

  Same enrollment

Listed as

Centracare Surgery Center LLCCCN 24C0001060

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Locations

Practitioners 3

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.

• Kevin S Jenner, M.D.

  • Anesthesiology Physician
  • Saint Cloud, MN
  • NPI 1508151853
  NPD
• Maria D Mallory, MD

  • Surgery Physician
  • Saint Cloud, MN
  • NPI 1689664344
  NPD
• Richard Kyle Maciver Martin, MD, FRCSC

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Saint Cloud, MN
  • NPI 1902381148
  NPD

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769385600000",
    "number": "1861538613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 CENTRACARE CIR",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563035000",
            "telephone_number": "320-229-4964",
            "fax_number": "320-229-5171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 CENTRACARE CIR",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563035000",
            "telephone_number": "320-229-4964",
            "fax_number": "320-229-5171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRACARE SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2026-01-26",
        "certification_date": "2026-01-26",
        "status": "A",
        "authorized_official_last_name": "BLAIR",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "320-255-5665"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Centracare Health System (CentraCare Laboratory Services)
• Centracare Health System (CentraCare Urgency Center)
• Centracare Health Systems (CentraCare Laboratory Services)
• Centracare Pharmacy Services LLC (Centracare Pharmacy Northway)
• Centracare Surgery Center (Midsota Surgical Suites)
• Central Imaging LLC (Alliance Imaging)
• Central Minnesota Anesthesia, LTD
• Central Minnesota Couseling Center, Inc.
• Central Minnesota Dementia Community Action Network
• Central Minnesota Foot & Ankle Associates,PA

• Ambulatory Surgical Clinic/Center in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Ambulatory Surgical Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2026; 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.