NPIMap

Organization Active NPI

Centracare Clinic

Doing business as Central Minnesota Child Advocacy Center (CAC)

  • Exclusive Provider Organization
  • Sartell, MN
National Provider Identifier
1962958611
Registry record updated Sep 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Exclusive Provider OrganizationTaxonomy code 302F00000X
Legal business name
CENTRACARE CLINIC
Doing business as
Central Minnesota Child Advocacy Center (CAC)
Practice address
1900 Centracare Cir Ste 1340
Sartell, MN 56303-5000
Phone
(320) 229-5105
Fax
(320) 200-3207
NPI assigned
Aug 31, 2016
Last updated
Sep 17, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2026

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

Authorized official

Name
Michael A Blair
Title
Sr VP & Cfo
Phone
(320) 255-5665

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Exclusive Provider Organization 302F00000X MN Primary

Addresses

Primary practice location

1900 Centracare Cir Ste 1340
Sartell, MN 56303-5000

Mailing address

PO Box 735818
Chicago, IL 60673-5818

Other names 1

  • Central Minnesota Child Advocacy Center (CAC) Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031105000293 MN Part B Supplier - Clinic/Group Practice 2466363395 Receives reassigned benefits from 1,127 practitioners
29 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 26

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

View all 26

National Provider Directory

National Provider Directory
Tax ID family
St Cloud Hospital12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Practitioners & affiliated clinicians

Practitioners 41

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.

View all 41

NPI Registry JSON

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

{
    "created_epoch": "1472601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789603200000",
    "number": "1962958611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735818",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 CENTRACARE CIR STE 1340",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563035000",
            "telephone_number": "320-229-5105",
            "fax_number": "320-200-3207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRACARE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-31",
        "last_updated": "2026-09-17",
        "certification_date": "2026-09-17",
        "status": "A",
        "authorized_official_last_name": "BLAIR",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "SR VP & CFO",
        "authorized_official_telephone_number": "320-255-5665"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Minnesota Child Advocacy Center (CAC)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sartell, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2026; 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.