Central Minnesota Retina Consultants, PLLC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

45473 Issued in MN

Legal business name

CENTRAL MINNESOTA RETINA CONSULTANTS, PLLC

Doing business as

Central Minnesota Retina Specialists

Practice address

2330 Troop Dr
Suite 104
Sartell, MN 56377-4530

Phone

(320) 230-8555

Fax

(320) 230-8556

NPI assigned

Dec 3, 2009

Last updated

Dec 3, 2009By 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

Mr. Dale S Reynolds, MD, PH. D.NPI 1578531364

Title

Owner

Phone

(320) 230-8555

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Central Minnesota Retina Specialists Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Interoperability endpoints

• Direct secure messaging: dreynolds@centralmnretina.intellechartdirect.net
• Direct secure messaging: vgullapalli@centralmnretina.intellechartdirect.net

Practitioners 2

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.

• Dale S Reynolds, M.D. PH.D.

  • Ophthalmology Physician
  • Sartell, MN
  • NPI 1578531364
  Medicare reassignment Care Compare group NPD Authorized official
• Vamsi Krishna Gullapalli, MD, PHD

  • Ophthalmology Physician
  • Sartell, MN
  • NPI 1649477787
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1259798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259798400000",
    "number": "1902134877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2330 TROOP DR",
            "address_2": "SUITE 104",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563774530",
            "telephone_number": "320-230-8555",
            "fax_number": "320-230-8556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2330 TROOP DR",
            "address_2": "SUITE 104",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563774530",
            "telephone_number": "320-230-8555",
            "fax_number": "320-230-8556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL MINNESOTA RETINA CONSULTANTS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-03",
        "last_updated": "2009-12-03",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "DALE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "320-230-8555",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD, PH. D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MN",
            "license": "45473",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807932300",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "569S2CE",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Minnesota Retina Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Centracare Clinic (CentraCare - Urology Clinic)
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• Centracare Clinic (Central Minnesota Child Advocacy Center (CAC))
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• Central Minnesota Endodontics, PA
• Central Minnesota Surgeons LTD
• Central Minnesota Surgical Center, LLC
• Changing Pathways LLC
• Ashley Nicole Chaos
• Alexandria B Chapman

• Ophthalmology Physician in Sartell, MN
• Providers in Sartell, MN by specialty
• Ophthalmology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2009; 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.