Brainerd Medical Center Inc.
Organization Active NPI Clinic Pharmacy · Staples, MN
NPI 1972350486 · NPPES record last updated Jul 3, 2024
Key facts
- NPI
- 1972350486
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic Pharmacy 3336C0002X
- Legal business name
- BRAINERD MEDICAL CENTER INC.
- 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
- Organization subpart
- Yes
- Parent organization (as reported)
- ESSENTIA HEALTH
Authorized official
- Name
- Kevin Boren
- Title
- VP of Finance
- Phone
- (218) 786-1009
Other NPIs on the same Medicare enrollment 6
Other NPIs with the same Medicare PAC ID 7
Corporate family (same tax ID) 9
Practitioners 145
-
Alind Zeki Amedi, MD
-
Jordan Benson, NP
-
Jessica Elin Berg, APRN/CNP
-
Michael John Curran, M.D.
-
Kaley Anne Gadbois, PA-C
-
Alec Ganske, M.D.
-
Lori A Gutierrez, WHCNP
-
Aditya Khurana, MD
-
Wade H Nedderman, MD
-
Samuel Nowicki, MD
-
Robert O Posch, M.D.
-
Alicia M Prahm, M.D.
-
Jared K Rustad, MD
-
Patricia Segler, MD
-
Dana Skonseng, MD
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Essentia Health Staples Pharmacy |
Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Brainerd Medical Center Inc
Locations
24087 Cuyuna St
#100
Deerwood, MN 56444
Phone (218) 833-5170
30581 Patriot Ave
Ste A
Pequot Lakes, MN 56472
Phone (218) 568-5884
301 2nd Ave NW
Ste 1010
Staples, MN 56479
Phone (218) 894-7850
301 2nd Ave NE
Ste 1010
Staples, MN 56479
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic Pharmacy | 3336C0002X | Yes |
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
- Essentia Health Staples Pharmacy
Other providers in Staples, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 3, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.