CENTRACARE CLINIC (NPI# 1659425114) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659425114 |
| Entity Type | Organization |
| Organization Name | CENTRACARE CLINIC |
| Other Organization Name | CENTRACARE CLINIC INTERNAL MEDICINE |
| Practice Address |
1900 Centracare Circle Centracare Clinic Internal Medicine St Cloud MN 56303 |
| Practice Telephone | 3202294928 |
| Mailing Telephone | 3202294928 |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2008-03-04 |
| Authorized Official Name | THOMAS M FELDHEGE (DIRECTOR OF FINANCE TREASURER) |
| Authorized Official Telephone | 3202402152 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| CentraCare Clinic Internal Medicine | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003339789 | Centracare Clinic | Clinic/Center | 2025 Stearns Way Ste 114, Saint Cloud, MN 56303 | 2017-07-25 |
| 1720500309 | Centracare Clinic | Clinic/Center | 2749 Sexton Drive, Mary Hall - Room 001, Collegeville, MN 56321 | 2017-07-14 |
| 1881116747 | Centracare Clinic | Clinic/Center | 402 Red River Ave N Ste 2, Cold Spring, MN 56320-1523 | 2017-07-12 |
| 1558898387 | Centracare Clinic | Clinic/Center | 161 Glen St., Ste 101, Foley, MN 56329 | 2017-05-11 |
| 1164958104 | Centracare Clinic | Clinic/Center | 113 Waite Ave S Ste 101, Waite Park, MN 56387-1348 | 2017-05-11 |
| 1770020489 | Centracare Clinic | Clinic/Center | 2001 Stockinger Drive, Suite 101, St Cloud, MN 56303 | 2017-01-20 |
| 1679025746 | Centracare Clinic | Clinic/Center | 7418 Forthun Rd, Baxter, MN 56425-8702 | 2016-10-25 |
| 1962958611 | Centracare Clinic | Exclusive Provider Organization | 166 19th Street S, Suite 202, Sartell, MN 56377 | 2016-08-31 |
| 1700281953 | Centracare Clinic | Urology | 2351 Connecticut Ave S, Suite 200, Centracare Clinic- Adult & Pediatric Urology, Sartell, MN 56377-2477 | 2014-10-30 |
| 1043212665 | Centracare Clinic | Clinic/Center | 1200 Sixth Ave No, Centracare Clinic, St Cloud, MN 56303-2735 | 2005-08-12 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | CENTRACARE CLINIC RIVER CAMPUS | 1200 6th Ave N, Saint Cloud, MN 56303-2735 |
| Street Address |
1900 CENTRACARE CIRCLE CENTRACARE CLINIC INTERNAL MEDICINE |
| City | ST CLOUD |
| State | MN |
| Zip Code | 56303 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003815051 | Jennifer J Rogan | Pediatrics | 1900 Centracare Circle, Centracare Clinic Womens & Childrens, St Cloud, MN 56303 | 2005-07-20 |
| 1659694628 | Bethany T. Dingmann | Dietitian, Registered | 1900 Centracare Circle, Suite 2500, St Cloud, MN 56303-5000 | 2010-03-05 |
| 1073708608 | Rachel Wenner Ruzanic | Dermatology | 1900 Centracare Circle, Centracare Clinic- Health Plaza Specialties, St Cloud, MN 56303-5000 | 2007-09-06 |
| 1982737938 | Daniel W Kraft | Internal Medicine | 1900 Centracare Circle, Centracare Clinic Health Plaza Gastroenterology, St Cloud, MN 56303 | 2007-03-13 |
| 1154466209 | Robin C Marushin | Obstetrics & Gynecology | 1900 Centracare Circle, Centracare Clinic Womens & Childrens, St Cloud, MN 56303 | 2007-02-20 |
| 1124173919 | David M Pence | Radiology | 1900 Centracare Circle, St Cloud, MN 56303 | 2007-01-24 |
| 1720155336 | Nelson L Adamson | Radiology | 1900 Centracare Circle, Centracare Clinic Health Plaza Specialties, St Cloud, MN 56303-5000 | 2006-11-29 |
| 1588734214 | Erin Y Scapanski | Physician Assistant | 1900 Centracare Circle, Centracare Clinic, St Cloud, MN 56303 | 2006-11-09 |
| 1639248065 | Donna F Johnson | Psychologist | 1900 Centracare Circle, Centracare Health Plaza, St Cloud, MN 56303 | 2006-11-07 |
| 1306944384 | Lori B Listug-lunde | Psychologist | 1900 Centracare Circle, St Cloud, MN 56303 | 2006-09-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841800463 | Daniel P Lahr | Radiologic Technologist | St Cloud Va Health Care System, 4801 Veterans Drive, St Cloud, MN 56303 | 2020-08-07 |
| 1730798398 | County of Stearns | Case Management | 705 Courthouse Square, St Cloud, MN 56303 | 2020-07-29 |
| 1669007126 | Aflah Transportation LLC | Non-emergency Medical Transport (VAN) | 3316 3rd Street North, Suite 129, Saint Cloud, MN 56303 | 2020-03-05 |
| 1609420942 | Stephanie Lynne Metzger | Nurse Practitioner | Centracare Clinic Riverc Ampus/nephrology, 1200 Sixth Ave North, St. Cloud, MN 56303 | 2019-07-25 |
| 1306406947 | Willow Tree Acupuncture LLC | Acupuncturist | 203 Cooper Ave N Suite 160, St. Cloud, MN 56303 | 2019-06-17 |
| 1821553520 | Alan Melvin Hoeper | Nurse Anesthetist, Certified Registered | Centracare Clinic Anesthesiology, 3701 12th St N, Suite 202, St. Cloud, MN 56303 | 2019-02-06 |
| 1437644465 | Brianna Larissa Justin | Speech-Language Pathologist | St. Cloud Hospital, 1406 6th Avenue N, St. Cloud, MN 56303 | 2018-06-22 |
| 1780186486 | Simplicity Health Pa | Family Medicine | 1511 Northway Dr Ste 103, Saint Cloud, MN 56303 | 2018-03-08 |
| 1639682925 | Dereje Beyene | Respiratory Therapist, Certified | 1406 15th Street North, Saint Cloud, MN 56303 | 2017-11-09 |
| 1740792761 | Lisa Ann Horner | Nurse Practitioner | 1555 Northway Drive #110, Centracare Complex Care Clinic, St Cloud, MN 56303 | 2017-10-31 |
| Find all providers in zip 56303 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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| 1902392525 | Odam Medical Group | Clinic/Center | 3405 3rd St N, Saint Cloud, MN 56303-4015 | 2018-07-06 |
| 1376041822 | Piic Clinical Services | Clinic/Center | 6500 Humboldt Ave N, Brooklyn Center, MN 55430-1800 | 2018-01-30 |
| 1760905475 | Patient Centered Care | Clinic/Center | 8240 Hampshire Ct N, Brooklyn Park, MN 55445 | 2017-07-25 |
| 1740703339 | Neopath | Clinic/Center | 119 30th Ave W Ste 119, Alexandria, MN 56308-3433 | 2017-07-25 |
| 1720500309 | Centracare Clinic | Clinic/Center | 2749 Sexton Drive, Mary Hall - Room 001, Collegeville, MN 56321 | 2017-07-14 |
| 1881116747 | Centracare Clinic | Clinic/Center | 402 Red River Ave N Ste 2, Cold Spring, MN 56320-1523 | 2017-07-12 |
| 1558898387 | Centracare Clinic | Clinic/Center | 161 Glen St., Ste 101, Foley, MN 56329 | 2017-05-11 |
| 1164958104 | Centracare Clinic | Clinic/Center | 113 Waite Ave S Ste 101, Waite Park, MN 56387-1348 | 2017-05-11 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.