NPIMap

Organization Active NPI

Centracare Health System - Long Prairie

  • Medicare Defined Swing Bed Hospital Unit
  • Long Prairie, MN
National Provider Identifier
1952359614
Registry record updated Oct 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
331051 Issued in MN
Legal business name
CENTRACARE HEALTH SYSTEM - LONG PRAIRIE
Practice address
50 Centracare Dr
Long Prairie, MN 56347
Phone
(320) 732-2141
NPI assigned
May 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2019

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 and Cfo
Phone
(320) 255-5665

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 331051 MN Primary

Addresses

Primary practice location

50 Centracare Dr
Long Prairie, MN 56347

Mailing address

50 Centra Care Dr
Long Prairie, MN 56347-2100
Phone (320) 256-4231

Other practice location 1

20 SE Ninth St
CentraCare Health System - Long Prairie
Long Prairie, MN 56347
Phone (320) 732-2141

Other practice location 2

20 SE Ninth St
CentraCare Health System - Long Prairie
Long Prairie, MN 56347-1404
Phone (320) 732-2141

Other practice location 3

20 SE Ninth St
CentraCare Health System - Long Prairie
Long Prairie, MN 56347
Phone (320) 732-2141

Other identifiers 1

IdentifierTypeStateIssuer
556717300MedicaidMN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080430000510 MN Part A Provider - Critical Access Hospital 3870524598 Practice locations: Long Prairie, MN

Hospital certification: CCN 24Z326

Legal name
CENTRACARE HEALTH SYSTEM - LONG PRAIRIE
Doing business as
CENTRACARE - LONG PRAIRIE SWING BED
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1999 in MN
Enrollment address
50 Centracare Dr
Long Prairie, MN 56347-2100

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

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 16

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 DirectorBoard Member 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 Employee Sep 30, 2019
Jeffrey Gau Individual Corporate DirectorBoard Member Jul 1, 2017
Renee S Frauendienst Individual Corporate Director Jul 1, 2017
Jacob Lyons Individual Corporate Director Jul 1, 2024
Richard Wehseler Individual Corporate DirectorBoard Member Apr 21, 2018
Bobbie Bertram Individual Corporate Director Jul 1, 2015
Kenneth D Holmen Individual Corporate DirectorBoard Member Jan 1, 2015
David Anfinson Individual Corporate DirectorBoard Member 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 Jul 1, 2023
Centracare Health System Organization, Saint Cloud, MN Non-profit Operational/Managerial Control Jan 1, 1999
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.

Facilities with the same owner 28

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 28

Practitioners & affiliated clinicians

Practitioners 45

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

View all 45

Affiliated clinicians 6

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

NPI Registry JSON

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570665600000",
    "number": "1952359614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 CENTRA CARE DR",
            "city": "LONG PRAIRIE",
            "state": "MN",
            "postal_code": "563472100",
            "telephone_number": "320-256-4231",
            "fax_number": "320-256-4949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 CENTRACARE DR",
            "city": "LONG PRAIRIE",
            "state": "MN",
            "postal_code": "56347",
            "telephone_number": "320-732-2141"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20 SE Ninth St",
            "address_2": "CentraCare Health System - Long Prairie",
            "address_purpose": "LOCATION",
            "city": "Long Prairie",
            "state": "MN",
            "postal_code": "56347",
            "country_code": "US",
            "telephone_number": "320-732-2141",
            "fax_number": "320-732-3802",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20 SE Ninth St",
            "address_2": "CentraCare Health System - Long Prairie",
            "address_purpose": "LOCATION",
            "city": "Long Prairie",
            "state": "MN",
            "postal_code": "563471404",
            "country_code": "US",
            "telephone_number": "320-732-2141",
            "fax_number": "320-732-3802",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20 SE Ninth St",
            "address_2": "CentraCare Health System - Long Prairie",
            "address_purpose": "LOCATION",
            "city": "Long Prairie",
            "state": "MN",
            "postal_code": "56347",
            "country_code": "US",
            "telephone_number": "320-732-2141",
            "fax_number": "320-732-3802",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CENTRACARE HEALTH SYSTEM - LONG PRAIRIE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2019-10-10",
        "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 AND CFO",
        "authorized_official_telephone_number": "320-255-5665",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "MN",
            "license": "331051",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "556717300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Prairie, MN

Sources for this page

Verify at the official NPI Registry.