NPIMap

Individual provider Active NPI

Lydia M Wade, M.D.

  • Obstetrics & Gynecology Physician
  • St Cloud, MN
National Provider Identifier
1992926893
Registry record updated Nov 11, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
52114 Issued in MN
Practice address
1900 Centra Care Circle
Centra Care Clinic - Women'S & Childrens
St Cloud, MN 56303-5000
Phone
(320) 654-3610
NPI assigned
May 1, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 52114 MN Primary
Obstetrics & Gynecology Physician 207V00000X 4301086305 MI

Addresses

Primary practice location

1900 Centra Care Circle
Centra Care Clinic - Women'S & Childrens
St Cloud, MN 56303-5000

Mailing address

1900 Centra Care Circle
Centra Care Clinic - Women'S & Childrens
St Cloud, MN 56303-5000
Phone (320) 654-3610

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091215000531 MN Practitioner - Obstetrics/Gynecology 0941340319 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Kansas School of Med (KC/Wich/Sal), 2005
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 N Ave
Saint Cloud, MN 56303-2735
Phone (320) 252-5131

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301086305MIMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic CurrentSince Sep 8, 2009 Accepting new patients
Centracare Clinic Current Accepting new patients
Centracare Health System-NR LLC CurrentSince Oct 17, 2018 Accepting new patients
Centracare Health System-NR LLC Current Accepting new patients
Centracare Clinic CurrentSince Sep 8, 2009 Accepting new patients
St. Cloud Hospital Past Accepting new patients
Centracare Clinic Past Accepting new patients

Locations

1013 Hart Blvd
Monticello, MN 55362
Phone (763) 271-2303

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

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

1900 Centracare Cir
Ste 2300
Saint Cloud, MN 56303
Phone (320) 654-3630

Interoperability endpoints

  • Direct secure messaging: lwade12609@direct.centracare.com

Organizations & group practices 7

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": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257897600000",
    "number": "1992926893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 CENTRA CARE CIRCLE",
            "address_2": "CENTRA CARE CLINIC - WOMEN'S & CHILDRENS",
            "city": "ST CLOUD",
            "state": "MN",
            "postal_code": "563035000",
            "telephone_number": "320-654-3610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 CENTRA CARE CIRCLE",
            "address_2": "CENTRA CARE CLINIC - WOMEN'S & CHILDRENS",
            "city": "ST CLOUD",
            "state": "MN",
            "postal_code": "563035000",
            "telephone_number": "320-654-3610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADE",
        "first_name": "LYDIA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-01",
        "last_updated": "2009-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MN",
            "license": "52114",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": "4301086305",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Cloud, MN

Sources for this page

Verify at the official NPI Registry.