Individual provider Active NPI

Christopher Tacl, M.D.

  • Family Medicine Physician
  • Saint Cloud, MN
National Provider Identifier
1972533776
Registry record updated Mar 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
028005 Issued in MN
Practice address
251 County Rd 120
Saint Cloud, MN 56303-4813
Phone
(320) 202-8949
Fax
(320) 202-0756
NPI assigned
Jul 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 028005 MN Primary

Addresses

Primary practice location

251 County Rd 120
Saint Cloud, MN 56303-4813

Mailing address

251 County Rd 120
Saint Cloud, MN 56303-4813
Phone (320) 202-8949

Other identifiers 1

IdentifierTypeStateIssuer
629767600MedicaidMN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ctacl1608@direct.centracare.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110323000254 MN Practitioner - Family Practice 3173508959

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
028005MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic Past Accepting new patients
Centracare Clinic Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678924800000",
    "number": "1972533776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "251 COUNTY RD 120",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563034813",
            "telephone_number": "320-202-8949",
            "fax_number": "320-202-0756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "251 COUNTY RD 120",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563034813",
            "telephone_number": "320-202-8949",
            "fax_number": "320-202-0756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACL",
        "first_name": "CHRISTOPHER",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "028005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "629767600",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ctacl1608@direct.centracare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "ctacl1608@direct.centracare.com",
            "address_1": "251 County Rd 120",
            "city": "Saint Cloud",
            "state": "MN",
            "country_code": "US",
            "postal_code": "563034813",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.