NPIMap

Organization Active NPI

Brainerd Medical Center Inc.

Doing business as Essentia Health Staples Pharmacy

  • Clinic Pharmacy
  • Staples, MN
National Provider Identifier
1972350486
Registry record updated Jul 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
Legal business name
BRAINERD MEDICAL CENTER INC.
Doing business as
Essentia Health Staples Pharmacy
Practice address
301 2ND Ave NW Ste 1010
Staples, MN 56479-3336
Phone
(218) 894-7850
Fax
(218) 894-7859
NPI assigned
May 2, 2024
Last updated
Jul 3, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ESSENTIA HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 3, 2024

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

Authorized official

Name
Kevin Boren
Title
VP of Finance
Phone
(218) 786-1009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X Primary

Addresses

Primary practice location

301 2ND Ave NW Ste 1010
Staples, MN 56479-3336

Mailing address

PO Box 34
Staples, MN 56479-0034
Phone (218) 894-7850

Other names 1

  • Essentia Health Staples Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20171013000866 MN Part B Supplier - Mass Immunization (Roster Biller Only) 0648270272 6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Baxter, MN; Brainerd, MN; Deerwood, MN; Pequot Lakes, MN; Pine River, MN; Staples, MN
O20241227000875 MN DME Supplier - Pharmacy 0648270272 Practice locations: Staples, MN

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 6

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

Laboratory certificates & supplier records

Derived by NPIMap

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

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Essentia Health Staples Pharmacy301 2ND Ave NW, Staples, MN 56479-3336(218) 894-7850 Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) Accepts assignmentParticipating since Jan 2, 2007

National Provider Directory

National Provider Directory
Tax ID family
Brainerd Medical Center Inc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

280 Barclay Ave W
Ste 1100
Pine River, MN 56474
Phone (218) 587-3222

301 2nd Ave NE
Ste 1010
Staples, MN 56479

301 2nd Ave NW
Ste 1010
Staples, MN 56479
Phone (218) 894-7850

Practitioners & affiliated clinicians

Practitioners 143

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 143

NPI Registry JSON

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

{
    "created_epoch": "1714608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719964800000",
    "number": "1972350486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34",
            "city": "STAPLES",
            "state": "MN",
            "postal_code": "564790034",
            "telephone_number": "218-894-7850",
            "fax_number": "218-894-7859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 2ND AVE NW STE 1010",
            "city": "STAPLES",
            "state": "MN",
            "postal_code": "564793336",
            "telephone_number": "218-894-7850",
            "fax_number": "218-894-7859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAINERD MEDICAL CENTER INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESSENTIA HEALTH",
        "enumeration_date": "2024-05-02",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A",
        "authorized_official_last_name": "BOREN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "218-786-1009"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Staples Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Essentia Health Staples Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Staples, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2024; 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.