| Samuel Thomas Goracke, CNP | |
|
6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | |
| (320) 424-0570 | |
| Not Available |
| Full Name | Samuel Thomas Goracke |
|---|---|
| Gender | Male |
| Speciality | Nurse Practitioner |
| Experience | 3 Years |
| Location | 6500 Excelsior Blvd, St Louis Park, Minnesota |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144905159 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 00000000 (Minnesota) | Secondary |
| 363L00000X | Nurse Practitioner | 10717 (Minnesota) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| St Croix Regional Medical Center | Saint croix falls, WI | Hospital |
| Glacial Ridge Hospital | Glenwood, MN | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Glacial Ridge Hospital District | 5294789194 | 69 |
| St. Croix Regional Medical Center | 9335032184 | 131 |
| St. Croix Regional Medical Center | 9335032184 | 131 |
| Entity Name | Grand Itasca Clinic and Hospital |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1669426631 PECOS PAC ID: 8123939550 Enrollment ID: O20031105000209 |
| Entity Name | Fairview Health Services |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1811077175 PECOS PAC ID: 1951213057 Enrollment ID: O20031105000461 |
| Entity Name | Range Regional Health Services |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1669569265 PECOS PAC ID: 8022920024 Enrollment ID: O20031110000095 |
| Entity Name | Glacial Ridge Hospital District |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1255348223 PECOS PAC ID: 5294789194 Enrollment ID: O20050719000315 |
| Entity Name | Glacial Ridge Hospital District |
|---|---|
| Entity Type | Part A Provider - Critical Access Hospital |
| Entity Identifiers | NPI Number: 1538178520 PECOS PAC ID: 5294789194 Enrollment ID: O20061104000464 |
| Mailing Address | Practice Location Address |
|---|---|
| Samuel Thomas Goracke, CNP 8170 33rd Ave S # Ms 21110q, Bloomington, MN 55425-4516 Ph: Not Available | Samuel Thomas Goracke, CNP 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 Ph: (320) 424-0570 |