Active NPI
Eitan Medini, MD
- Radiation Oncology Physician
- St Cloud, MN
National Provider Identifier
1962493643
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiation Oncology Physician
- License
- 21866
- Practice address
- 1900 Centra Care Cir #1600
Centra Care Clinic Health Plaza / Radiation Oncology
St Cloud, MN 56303-5000 - Phone
- (320) 229-4901
- Fax
- (320) 229-5160
- NPI assigned
- Nov 2, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiation Oncology Physician | 2085R0001X | 21866 | MN | Primary |
Addresses
Primary practice location
1900 Centra Care Cir #1600
Centra Care Clinic Health Plaza / Radiation Oncology
St Cloud, MN 56303-5000
Mailing address
1900 Centra Care Cir #1600
Centra Care Clinic Health Plaza / Radiation Oncology
St Cloud, MN 56303-5000
Phone (320) 229-4901
Other identifiers 12
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1027482 | Other | PREFERRED ONE | |
| 512RIME | Other | BLUE CROSS BLUE SHIELD | |
| COMP | Other | FIRST HEALTH PLAN | |
| COMP | Other | MMSI | |
| 315JOME | Other | BLUE CROSS BLUE SHIELD | |
| 978660 | Other | ARAZ GROUP AMERICAS PPO | |
| 2400101 | Other | MEDICA HEALTH PLANS | |
| 252563100 | Medicaid | MN | |
| COMP | Other | ONE HEALTH PLAN GREAT WES | |
| 127789 | Other | U CARE | |
| COMP | Other | CHAMPUS | |
| HP33037 | Other | HEALTH PARTNERS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21866 | MN | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Allina Health System | Past | Accepting new patients | |
| Metropolitan Anesthesia Network, LLP | Past | Accepting new patients | |
| Centracare Clinic | Past | Accepting new patients | |
| Centracare Clinic | Past | Accepting new patients |
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312934400000",
"number": "1962493643",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 CENTRA CARE CIR #1600",
"address_2": "CENTRA CARE CLINIC HEALTH PLAZA / RADIATION ONCOLOGY",
"city": "ST CLOUD",
"state": "MN",
"postal_code": "563035000",
"telephone_number": "320-229-4901",
"fax_number": "320-229-5160"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 CENTRA CARE CIR #1600",
"address_2": "CENTRA CARE CLINIC HEALTH PLAZA / RADIATION ONCOLOGY",
"city": "ST CLOUD",
"state": "MN",
"postal_code": "563035000",
"telephone_number": "320-229-4901",
"fax_number": "320-229-5160"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINI",
"first_name": "EITAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-02",
"last_updated": "2011-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0001X",
"taxonomy_group": "",
"desc": "Radiology, Radiation Oncology",
"state": "MN",
"license": "21866",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "1027482",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "512RIME",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST HEALTH PLAN",
"identifier": "COMP",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MMSI",
"identifier": "COMP",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "315JOME",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ARAZ GROUP AMERICAS PPO",
"identifier": "978660",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA HEALTH PLANS",
"identifier": "2400101",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "252563100",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ONE HEALTH PLAN GREAT WES",
"identifier": "COMP",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "U CARE",
"identifier": "127789",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS",
"identifier": "COMP",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "HP33037",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in St Cloud, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.