Individual provider Active NPI

Jill T Stang, ANP

  • Adult Health Nurse Practitioner
  • St Cloud, MN
National Provider Identifier
1992796841
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
R1237351 Issued in MN
Practice address
1520 Northway Court
Centracare Clinic Heartland
St Cloud, MN 56303
Phone
(320) 251-1775
Fax
(320) 240-3131
NPI assigned
Oct 31, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X R1237351 MN Primary

Addresses

Primary practice location

1520 Northway Court
Centracare Clinic Heartland
St Cloud, MN 56303

Mailing address

1520 Northway Court
Centracare Clinic Heartland
St Cloud, MN 56303
Phone (320) 251-1775

Other identifiers 7

IdentifierTypeStateIssuer
002219500OtherMEDICAL ASSISTANCE
1014181OtherPREFERRED ONE
86D79STOtherBLUE CROSS BLUE SHIELD
HP23116OtherHEALTH PARTNERS
R1237351OtherMN LICENSE NUMBER
0110555OtherMEDICA HEALTH PLANS
122925OtherU CARE

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080303000285 MN Practitioner - Nurse Practitioner 1951485853 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

1200 6TH Ave N
Saint Cloud, MN 56303-2735

1200 6TH N Ave
Saint Cloud, MN 56303-2735
Phone (320) 252-5131

12800 Rolling Ridge Rd
Becker, MN 55308-8838
Phone (763) 261-7000

1555 Northway Dr
100 Centra Care Clinic Northway Family
St Cloud, MN 56303-1258
Phone (320) 251-1775

PO Box
Chicago, IL 60673

Hospital & facility affiliations

  • Centracare - St. Cloud Hospital Hospital, Saint Cloud, MN, CCN 240036

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R1237351MNMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic Current Accepting new patients
Centracare Clinic CurrentSince Jan 1, 2008 Accepting new patients
Centracare Clinic CurrentSince Jan 1, 2008 Accepting new patients
Centracare Clinic Past Accepting new patients
Centracare Clinic Past Accepting new patients

Locations

12800 Rolling Ridge Rd
Becker, MN 55308
Phone (763) 261-7000

715 1st St N
Cold Spring, MN 56320
Phone (320) 685-3693

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1555 Northway Dr
Ste 100
Saint Cloud, MN 56303
Phone (320) 240-3114

Interoperability endpoints

  • Direct secure messaging: jstang846@direct.centracare.com

Organizations & group practices 5

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1992796841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 NORTHWAY COURT",
            "address_2": "CENTRACARE CLINIC HEARTLAND",
            "city": "ST CLOUD",
            "state": "MN",
            "postal_code": "56303",
            "telephone_number": "320-251-1775",
            "fax_number": "320-240-3131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 NORTHWAY COURT",
            "address_2": "CENTRACARE CLINIC HEARTLAND",
            "city": "ST CLOUD",
            "state": "MN",
            "postal_code": "56303",
            "telephone_number": "320-251-1775",
            "fax_number": "320-240-3131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANG",
        "first_name": "JILL",
        "middle_name": "T",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-31",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MN",
            "license": "R1237351",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL ASSISTANCE",
            "identifier": "002219500",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1014181",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "86D79ST",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP23116",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN LICENSE NUMBER",
            "identifier": "R1237351",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA HEALTH PLANS",
            "identifier": "0110555",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "U CARE",
            "identifier": "122925",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Cloud, MN

Sources for this page

Verify at the official NPI Registry.