| Centracare Health - Paynesville Clinic | |
|
200 W 1st St Paynesville MN 56362-1445 | |
| (320) 243-3767 | |
| (320) 243-3174 |
| Full Name | Centracare Health - Paynesville Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 200 W 1st St, Paynesville, Minnesota |
| Authorized Official Name and Position | Michael A. Blair (SR. VICE PRESIDENT AND CFO) |
| Authorized Official Contact | 3202555665 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Centracare Health - Paynesville Clinic 200 W 1st St Paynesville MN 56362-1445 Ph: (320) 243-3767 | Centracare Health - Paynesville Clinic 200 W 1st St Paynesville MN 56362-1445 Ph: (320) 243-3767 |
| NPI Number | 1629402516 |
|---|---|
| Provider Enumeration Date | 08/27/2013 |
| Last Update Date | 10/10/2019 |
| Medicare PECOS PAC ID | 1153555719 |
|---|---|
| Medicare Enrollment ID | O20140909002390 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629402516 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | John E Mertz |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1346217874 PECOS PAC ID: 2769396373 Enrollment ID: I20031118000430 |
| Provider Name | Julie K Youngs |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538136882 PECOS PAC ID: 6608777677 Enrollment ID: I20040114000418 |
| Provider Name | Randall J Zimmerman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821005638 PECOS PAC ID: 8921995259 Enrollment ID: I20040302000604 |
| Provider Name | Lawrence G Strate |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124052782 PECOS PAC ID: 1153316302 Enrollment ID: I20040416001139 |
| Provider Name | Melissa L Dols |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1144288754 PECOS PAC ID: 7719969641 Enrollment ID: I20040604000026 |
| Provider Name | Julie A Klasen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255312955 PECOS PAC ID: 2163499849 Enrollment ID: I20040913000763 |
| Provider Name | Timothy L Malling |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548277668 PECOS PAC ID: 2567356967 Enrollment ID: I20041123001084 |
| Provider Name | Christopher D Leville |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1699776310 PECOS PAC ID: 0749221398 Enrollment ID: I20050513000550 |
| Provider Name | Paul E Vangorp |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639160898 PECOS PAC ID: 8729020375 Enrollment ID: I20050524001342 |
| Provider Name | Maria D Mallory |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1689664344 PECOS PAC ID: 8628008109 Enrollment ID: I20050815000536 |
| Provider Name | Kurt A Martinson |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1245281302 PECOS PAC ID: 8820066889 Enrollment ID: I20060605000148 |
| Provider Name | Theodore W Ruzanic |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1932273943 PECOS PAC ID: 6002816113 Enrollment ID: I20070112000338 |
| Provider Name | Mariola Z Kruk Czapiewska |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306948518 PECOS PAC ID: 3779584230 Enrollment ID: I20070712000129 |
| Provider Name | Timothy M Peterson |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1306055355 PECOS PAC ID: 9436250099 Enrollment ID: I20070726000205 |
| Provider Name | Kurt A Habben |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972794865 PECOS PAC ID: 3476629106 Enrollment ID: I20080904000148 |
| Provider Name | Deborah F Libbesmeier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073761557 PECOS PAC ID: 7719045962 Enrollment ID: I20081017000078 |
| Provider Name | Joel E Dunn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922299197 PECOS PAC ID: 8628130366 Enrollment ID: I20081215000450 |
| Provider Name | Nathaniel Reuter |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1457479446 PECOS PAC ID: 8921199373 Enrollment ID: I20090924000337 |
| Provider Name | Jane K Willett |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548236292 PECOS PAC ID: 4789727769 Enrollment ID: I20100130000350 |
| Provider Name | Christian P Schmidt |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1497745152 PECOS PAC ID: 1052455318 Enrollment ID: I20100224000643 |
| Provider Name | Paul Joseph Mitchell |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1770573420 PECOS PAC ID: 4284779174 Enrollment ID: I20100303000430 |
| Provider Name | Gregory S Parries |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1891739538 PECOS PAC ID: 8628964756 Enrollment ID: I20100504000877 |
| Provider Name | April M Stadtler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821360579 PECOS PAC ID: 1153576988 Enrollment ID: I20130228000474 |
| Provider Name | Andrea M Lundeen |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1730344664 PECOS PAC ID: 8426290826 Enrollment ID: I20130814000976 |
| Provider Name | Angela L Beyerl |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457793531 PECOS PAC ID: 5496989634 Enrollment ID: I20131002000031 |
| Provider Name | Michael J Beste |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700220712 PECOS PAC ID: 2668699109 Enrollment ID: I20140807000616 |
| Provider Name | Alicia M Glimsdal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225449192 PECOS PAC ID: 8426366675 Enrollment ID: I20151007002875 |
| Provider Name | Rebecca K Stepan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336409507 PECOS PAC ID: 7810206984 Enrollment ID: I20151013000818 |
| Provider Name | Angie L Paschke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518410612 PECOS PAC ID: 2466732789 Enrollment ID: I20161202001222 |
| Provider Name | Janelle M Terhaar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144758228 PECOS PAC ID: 4284905787 Enrollment ID: I20170802000009 |
| Provider Name | Christopher R Anderson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447679188 PECOS PAC ID: 1951528652 Enrollment ID: I20170808002393 |
| Provider Name | Daniel B Pickett |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1174866644 PECOS PAC ID: 9133475478 Enrollment ID: I20180628003150 |
| Provider Name | Damon M Campbell |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1518285816 PECOS PAC ID: 3375771744 Enrollment ID: I20180716000172 |
| Provider Name | Clarence O Ojo |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1053650630 PECOS PAC ID: 3072747021 Enrollment ID: I20180810003100 |
| Provider Name | Jennifer R Tomford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346727211 PECOS PAC ID: 6103176417 Enrollment ID: I20180907001267 |
| Provider Name | Ryan O Mareck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508344391 PECOS PAC ID: 8921359613 Enrollment ID: I20180919001619 |
| Provider Name | Jason A Glenn |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1861791386 PECOS PAC ID: 9032438551 Enrollment ID: I20181018000148 |
| Provider Name | Elaine M Thelen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720565617 PECOS PAC ID: 4880947928 Enrollment ID: I20181019000673 |
| Provider Name | Nicole J Lyons |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1013336106 PECOS PAC ID: 0143525303 Enrollment ID: I20190731001185 |
| Provider Name | Kristin M Pomplun |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104467935 PECOS PAC ID: 2769811470 Enrollment ID: I20200401000514 |
| Provider Name | Wade E Paulson |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1447645916 PECOS PAC ID: 1355656984 Enrollment ID: I20200526000075 |
| Provider Name | Ginelle R Zimmerman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174055321 PECOS PAC ID: 8224300405 Enrollment ID: I20200805002213 |
| Provider Name | Daniel J O'connor |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093248536 PECOS PAC ID: 7517237357 Enrollment ID: I20200826003563 |
| Provider Name | Nicole L Stommes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407047640 PECOS PAC ID: 7012336845 Enrollment ID: I20200929001021 |
| Provider Name | Crystal L Fleischhacker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356956601 PECOS PAC ID: 5698187185 Enrollment ID: I20201207000657 |
| Provider Name | Samuel T Burns |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922428077 PECOS PAC ID: 1254653595 Enrollment ID: I20210222000809 |
| Provider Name | Robert H Krieger |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1912367103 PECOS PAC ID: 0143625749 Enrollment ID: I20210819002716 |
| Provider Name | Elizabeth A Tacl |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1093194706 PECOS PAC ID: 7618289554 Enrollment ID: I20210923003000 |
| Provider Name | Lindsey M Beckman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013686955 PECOS PAC ID: 9830587047 Enrollment ID: I20211020002024 |
| Provider Name | Jennifer K Lund |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023780335 PECOS PAC ID: 1153710306 Enrollment ID: I20211110000882 |
| Provider Name | Bashir S Moallin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144840463 PECOS PAC ID: 6608299821 Enrollment ID: I20220510002368 |
| Provider Name | Lisa N Angell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760142046 PECOS PAC ID: 8325425838 Enrollment ID: I20220520002055 |
| Provider Name | Wesley J Halseth |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1891227971 PECOS PAC ID: 3678844867 Enrollment ID: I20220921002720 |
| Provider Name | Kayla Beckmann |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1013637990 PECOS PAC ID: 4587035316 Enrollment ID: I20230113001778 |
| Provider Name | Michael Kihiu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578275798 PECOS PAC ID: 3072985936 Enrollment ID: I20230202002719 |
| Provider Name | Sydni Imel |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1689034027 PECOS PAC ID: 3870977267 Enrollment ID: I20230707001671 |
| Provider Name | Austin Grant Hewitt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699451740 PECOS PAC ID: 0446610653 Enrollment ID: I20230720000212 |
| Provider Name | Jason Hogge |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1952044927 PECOS PAC ID: 5496134041 Enrollment ID: I20240103000095 |
Branta Home & Community Supports Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 242 Spruce St, Paynesville, MN 56362 Phone: 320-380-4898 |