Centracare Clinic Southwest Llc | |
101 Willmar Ave Sw Willmar MN 56201-3556 | |
(320) 231-5000 | |
Not Available |
Full Name | Centracare Clinic Southwest Llc |
---|---|
Speciality | Clinic/Center |
Location | 101 Willmar Ave Sw, Willmar, Minnesota |
Authorized Official Name and Position | Michael Blair (CFO) |
Authorized Official Contact | 3202555665 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Centracare Clinic Southwest Llc 1200 6th Ave N Saint Cloud MN 56303-2735 Ph: (320) 251-2700 | Centracare Clinic Southwest Llc 101 Willmar Ave Sw Willmar MN 56201-3556 Ph: (320) 231-5000 |
NPI Number | 1174106264 |
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Provider Enumeration Date | 05/05/2021 |
Last Update Date | 04/18/2022 |
Medicare PECOS PAC ID | 8426457946 |
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Medicare Enrollment ID | O20210602002802 |
Identifier | Type | State | Issuer |
---|---|---|---|
1174106264 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
Provider Name | Andrew A Hoffmann |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1457374035 PECOS PAC ID: 1658273644 Enrollment ID: I20040121000723 |
Provider Name | Thomas Campbell |
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Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1285610774 PECOS PAC ID: 2062305246 Enrollment ID: I20040203000239 |
Provider Name | Kimberly D Rupp-montpetit |
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Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1114023967 PECOS PAC ID: 3173416021 Enrollment ID: I20040204000683 |
Provider Name | Steven J Kuchta |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1962572974 PECOS PAC ID: 4688568157 Enrollment ID: I20040214000149 |
Provider Name | Shannon L Elton |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1245300250 PECOS PAC ID: 0244125516 Enrollment ID: I20040216001247 |
Provider Name | Douglas M Soderberg |
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Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1215997952 PECOS PAC ID: 1557358066 Enrollment ID: I20040427001347 |
Provider Name | Eric J Christensen |
---|---|
Provider Type | Practitioner - Qualified Audiologist |
Provider Identifiers | NPI Number: 1104996123 PECOS PAC ID: 0547259350 Enrollment ID: I20040507000697 |
Provider Name | Todd R Stoeberl |
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Provider Type | Practitioner - Qualified Audiologist |
Provider Identifiers | NPI Number: 1013087030 PECOS PAC ID: 7214926021 Enrollment ID: I20040507000740 |
Provider Name | Eric J Peterson |
---|---|
Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1265436059 PECOS PAC ID: 0244220952 Enrollment ID: I20040514000754 |
Provider Name | Jaime Schlomann |
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Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
Provider Identifiers | NPI Number: 1598955858 PECOS PAC ID: 9133100373 Enrollment ID: I20040525001072 |
Provider Name | Shelly M Staska |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1114097136 PECOS PAC ID: 9830179746 Enrollment ID: I20040721001631 |
Provider Name | Ina Drown |
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Provider Type | Practitioner - Ophthalmology |
Provider Identifiers | NPI Number: 1104872324 PECOS PAC ID: 0143290346 Enrollment ID: I20040727000425 |
Provider Name | Craig M Doschadis |
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Provider Type | Practitioner - Anesthesiology |
Provider Identifiers | NPI Number: 1265423925 PECOS PAC ID: 9830162734 Enrollment ID: I20040818000822 |
Provider Name | Steven P Strinden |
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Provider Type | Practitioner - Urology |
Provider Identifiers | NPI Number: 1639108814 PECOS PAC ID: 1456327501 Enrollment ID: I20040913000267 |
Provider Name | Jessica A Wentzell |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1447280847 PECOS PAC ID: 7618936477 Enrollment ID: I20041007000135 |
Provider Name | Jay E Loeppke |
---|---|
Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1669551974 PECOS PAC ID: 4284695586 Enrollment ID: I20041020000775 |
Provider Name | Gregory M Macik |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1922004514 PECOS PAC ID: 2769445006 Enrollment ID: I20041108001215 |
Provider Name | Ann Marie M Nelson |
---|---|
Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1710983473 PECOS PAC ID: 7911951801 Enrollment ID: I20050303000294 |
Provider Name | Rachel L Tollefsrud |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1144243833 PECOS PAC ID: 3870548332 Enrollment ID: I20050317000227 |
Provider Name | Rwanda D Campbell |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1174599641 PECOS PAC ID: 5799713129 Enrollment ID: I20050727001129 |
Provider Name | Shawn M Mcgee |
---|---|
Provider Type | Practitioner - Urology |
Provider Identifiers | NPI Number: 1427023514 PECOS PAC ID: 2567493877 Enrollment ID: I20050826000215 |
Provider Name | Maria J Loerzel |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1053390377 PECOS PAC ID: 5890727341 Enrollment ID: I20050906000293 |
Provider Name | Shane P Volk |
---|---|
Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1972626703 PECOS PAC ID: 3971518697 Enrollment ID: I20060215000816 |
Provider Name | Craig John Bergh |
---|---|
Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1780649715 PECOS PAC ID: 5890705917 Enrollment ID: I20060504000026 |
Provider Name | Kurt A Martinson |
---|---|
Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1245281302 PECOS PAC ID: 8820066889 Enrollment ID: I20060605000148 |
Provider Name | Kristel L Arcilla |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1982618674 PECOS PAC ID: 0941203277 Enrollment ID: I20060807000173 |
Provider Name | Amber O Vick |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1972519213 PECOS PAC ID: 2567465776 Enrollment ID: I20060808000415 |
Provider Name | Grayson J Swalin |
---|---|
Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1174548986 PECOS PAC ID: 1951304054 Enrollment ID: I20060810000135 |
Provider Name | Daniel W Schminke |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1770580771 PECOS PAC ID: 3971507229 Enrollment ID: I20060829000538 |
Provider Name | Cindy Firkins Smith |
---|---|
Provider Type | Practitioner - Dermatology |
Provider Identifiers | NPI Number: 1033185343 PECOS PAC ID: 7810893674 Enrollment ID: I20061017000138 |
Provider Name | Adam K Mooberry |
---|---|
Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1134327703 PECOS PAC ID: 8123119930 Enrollment ID: I20070808000706 |
Provider Name | Charles Dean Ulrich |
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Provider Type | Practitioner - Gastroenterology |
Provider Identifiers | NPI Number: 1790741080 PECOS PAC ID: 6901894914 Enrollment ID: I20070810000296 |
Provider Name | Timothy S Mulder |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1336131747 PECOS PAC ID: 1658463211 Enrollment ID: I20070828000020 |
Provider Name | Raza A Khan |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1669584249 PECOS PAC ID: 3173616950 Enrollment ID: I20070910000997 |
Provider Name | Soumathy Prosper |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1629271671 PECOS PAC ID: 0143315630 Enrollment ID: I20070928000070 |
Provider Name | Mary M Amon |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1518902998 PECOS PAC ID: 3072599513 Enrollment ID: I20071017000083 |
Provider Name | Amanda J Buckingham |
---|---|
Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1447446455 PECOS PAC ID: 0345337382 Enrollment ID: I20071107000505 |
Provider Name | Pamela J Reinertson |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1740460971 PECOS PAC ID: 8123108784 Enrollment ID: I20080108000859 |
Provider Name | Ryan C Hebrink |
---|---|
Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1003077439 PECOS PAC ID: 8325111727 Enrollment ID: I20080717000735 |
Provider Name | Michael A May |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1619142742 PECOS PAC ID: 2062586977 Enrollment ID: I20080811000107 |
Provider Name | Aimee L Tebrake |
---|---|
Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
Provider Identifiers | NPI Number: 1467558197 PECOS PAC ID: 5193884070 Enrollment ID: I20081106000633 |
Provider Name | Debra G Peterson |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1326000241 PECOS PAC ID: 0840341921 Enrollment ID: I20090701000110 |
Provider Name | Kene Gina Ogbogu |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1447424247 PECOS PAC ID: 8123173572 Enrollment ID: I20090908000602 |
Provider Name | Jessica R Baitani |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1285800466 PECOS PAC ID: 6507912334 Enrollment ID: I20090921000434 |
Provider Name | Nathaniel Reuter |
---|---|
Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1457479446 PECOS PAC ID: 8921199373 Enrollment ID: I20090924000337 |
Provider Name | Christina B Ferdinand |
---|---|
Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1750445433 PECOS PAC ID: 6901942978 Enrollment ID: I20091005000442 |
Provider Name | Daniel S Fuglestad |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1215903935 PECOS PAC ID: 2163562042 Enrollment ID: I20091228000506 |
Provider Name | Mark R Johnston |
---|---|
Provider Type | Practitioner - Podiatry |
Provider Identifiers | NPI Number: 1912973058 PECOS PAC ID: 8527109354 Enrollment ID: I20091230000566 |
Provider Name | Frederick W Hund |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1427036573 PECOS PAC ID: 0749378115 Enrollment ID: I20100109000208 |
Provider Name | Kendall S Bos |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1427024561 PECOS PAC ID: 2567503725 Enrollment ID: I20100109000292 |
Provider Name | David A Newcomer |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1619943438 PECOS PAC ID: 5395833750 Enrollment ID: I20100109000302 |
Provider Name | Alan J Roiseland |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1275553117 PECOS PAC ID: 1254317795 Enrollment ID: I20100111000676 |
Provider Name | Anthony G Amon |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1972526564 PECOS PAC ID: 1355327891 Enrollment ID: I20100111000685 |
Provider Name | Thomas H Lange |
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Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1215903000 PECOS PAC ID: 0446391593 Enrollment ID: I20100111000823 |
Provider Name | Michael G Nicklawsky |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1841266152 PECOS PAC ID: 3072654128 Enrollment ID: I20100111000827 |
Provider Name | Gabrielle A Vencel Olson |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1306812185 PECOS PAC ID: 6709927858 Enrollment ID: I20100111000831 |
Provider Name | Alan G Olson |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1619943081 PECOS PAC ID: 2769570126 Enrollment ID: I20100208000268 |
Provider Name | Gregory G Mccallum |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1689642282 PECOS PAC ID: 8527103514 Enrollment ID: I20100302000375 |
Provider Name | Jeffrey Ja Enstad |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1104885888 PECOS PAC ID: 8325173461 Enrollment ID: I20100315000926 |
Provider Name | Wayne R Jandik |
---|---|
Provider Type | Practitioner - Anesthesiology |
Provider Identifiers | NPI Number: 1174514731 PECOS PAC ID: 1254221971 Enrollment ID: I20100824001262 |
Provider Name | Theodore A Peterson |
---|---|
Provider Type | Practitioner - Anesthesiology |
Provider Identifiers | NPI Number: 1457342628 PECOS PAC ID: 2860382512 Enrollment ID: I20100824001296 |
Provider Name | Chad M Kissela |
---|---|
Provider Type | Practitioner - Anesthesiology |
Provider Identifiers | NPI Number: 1912998584 PECOS PAC ID: 6204726946 Enrollment ID: I20100824001305 |
Provider Name | Leslee J Jaeger |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1346286838 PECOS PAC ID: 4082738208 Enrollment ID: I20100825000300 |
Provider Name | John W Seifert |
---|---|
Provider Type | Practitioner - Anesthesiology |
Provider Identifiers | NPI Number: 1205802931 PECOS PAC ID: 8022133966 Enrollment ID: I20100915000424 |
Provider Name | Anjali Dahiya |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1275709420 PECOS PAC ID: 2961528856 Enrollment ID: I20100928001714 |
Provider Name | Richard A Wehseler |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1609842335 PECOS PAC ID: 3476745274 Enrollment ID: I20101012001040 |
Provider Name | Eric M Hernandez |
---|---|
Provider Type | Practitioner - Neurology |
Provider Identifiers | NPI Number: 1154514487 PECOS PAC ID: 1557553351 Enrollment ID: I20101012001049 |
Provider Name | Laurie Claussen O'leary |
---|---|
Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1619286184 PECOS PAC ID: 2961681838 Enrollment ID: I20110124001247 |
Provider Name | John P Skretvedt |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1356532535 PECOS PAC ID: 4385825413 Enrollment ID: I20110223000422 |
Provider Name | Somendra Vaishnav |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1609043843 PECOS PAC ID: 1658552278 Enrollment ID: I20110301001136 |
Provider Name | Scott M Abrams |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1265498430 PECOS PAC ID: 5496937807 Enrollment ID: I20110307000552 |
Provider Name | Joyce A Tarbet |
---|---|
Provider Type | Practitioner - Orthopedic Surgery |
Provider Identifiers | NPI Number: 1902836109 PECOS PAC ID: 7517047830 Enrollment ID: I20110406000860 |
Provider Name | Leah M Schammel |
---|---|
Provider Type | Practitioner - Dermatology |
Provider Identifiers | NPI Number: 1467644450 PECOS PAC ID: 9133307416 Enrollment ID: I20110711000469 |
Provider Name | Nathan D Lee |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1962677518 PECOS PAC ID: 3870761570 Enrollment ID: I20110725000410 |
Provider Name | Jenell R Mitteness |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1316162886 PECOS PAC ID: 3072786334 Enrollment ID: I20111101000628 |
Provider Name | Diane D Zorn |
---|---|
Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1285704296 PECOS PAC ID: 3779740840 Enrollment ID: I20120131000940 |
Provider Name | Julianne A Wurm |
---|---|
Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1437213121 PECOS PAC ID: 0941467682 Enrollment ID: I20120207000727 |
Provider Name | Lucio R Minces |
---|---|
Provider Type | Practitioner - Infectious Disease |
Provider Identifiers | NPI Number: 1811173271 PECOS PAC ID: 3072791003 Enrollment ID: I20121002000539 |
Provider Name | Kari L Mobley |
---|---|
Provider Type | Practitioner - Qualified Audiologist |
Provider Identifiers | NPI Number: 1437381985 PECOS PAC ID: 9335277177 Enrollment ID: I20121022000195 |
Provider Name | Tanya L Smith |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1366792319 PECOS PAC ID: 5193976488 Enrollment ID: I20121114000377 |
Provider Name | Shannon L Larson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1972853208 PECOS PAC ID: 3375795115 Enrollment ID: I20121130000449 |
Provider Name | Brennen Gulden |
---|---|
Provider Type | Practitioner - Occupational Therapist In Private Practice |
Provider Identifiers | NPI Number: 1043576275 PECOS PAC ID: 7810132206 Enrollment ID: I20130408000476 |
Provider Name | Nadiya Beliveau |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1366694341 PECOS PAC ID: 8022283373 Enrollment ID: I20130418000329 |
Provider Name | Claire H Dutton |
---|---|
Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1386987378 PECOS PAC ID: 3779720255 Enrollment ID: I20130501000387 |
Provider Name | Ryan R Davis |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1427374123 PECOS PAC ID: 7719150242 Enrollment ID: I20130722000201 |
Provider Name | Jayme L Vanbeek |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1518246826 PECOS PAC ID: 2062653751 Enrollment ID: I20130723000214 |
Provider Name | Jessica Jo Martinez |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1659710820 PECOS PAC ID: 5799926796 Enrollment ID: I20130801000747 |
Provider Name | Kiran K Lingala |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1154636926 PECOS PAC ID: 3476787383 Enrollment ID: I20131009000131 |
Provider Name | David M Truscinski |
---|---|
Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1083059075 PECOS PAC ID: 1557596236 Enrollment ID: I20131105001514 |
Provider Name | Emily Louise Bakker |
---|---|
Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
Provider Identifiers | NPI Number: 1699102152 PECOS PAC ID: 6204062656 Enrollment ID: I20131113001971 |
Provider Name | Kristina A Kase |
---|---|
Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1609218833 PECOS PAC ID: 7810123544 Enrollment ID: I20131202000307 |
Provider Name | James E Malkuch |
---|---|
Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1053747667 PECOS PAC ID: 1850529264 Enrollment ID: I20140110000134 |
Provider Name | Michael Y Lee |
---|---|
Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1902003825 PECOS PAC ID: 1355572645 Enrollment ID: I20140331001055 |
Provider Name | Noelle E Lee |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1790967347 PECOS PAC ID: 4284767930 Enrollment ID: I20140408000145 |
Provider Name | Andrew Peter Windsperger |
---|---|
Provider Type | Practitioner - Urology |
Provider Identifiers | NPI Number: 1124280425 PECOS PAC ID: 8426297623 Enrollment ID: I20140516001300 |
Provider Name | Dexter R Casta |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1194043034 PECOS PAC ID: 2365566205 Enrollment ID: I20140609001817 |
Provider Name | Cory Alan Yarke |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1346536885 PECOS PAC ID: 7911123369 Enrollment ID: I20140722000418 |
Provider Name | Jacob W Eiler |
---|---|
Provider Type | Practitioner - Anesthesiology |
Provider Identifiers | NPI Number: 1255656997 PECOS PAC ID: 8224261979 Enrollment ID: I20140926000795 |
Provider Name | Charles Snow |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1689745747 PECOS PAC ID: 4284804840 Enrollment ID: I20141015002408 |
Provider Name | Kellie Ann Prentice |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1245635820 PECOS PAC ID: 1355663659 Enrollment ID: I20141121001801 |
Provider Name | Laamy Tiadjeri |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1861705022 PECOS PAC ID: 0244469005 Enrollment ID: I20150122001436 |
Provider Name | Nancy J Rost |
---|---|
Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1770555344 PECOS PAC ID: 4183766538 Enrollment ID: I20150603001274 |
Provider Name | Lana J Dirksen |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1316381965 PECOS PAC ID: 9436460565 Enrollment ID: I20150616002506 |
Provider Name | Awani A Deshmukh |
---|---|
Provider Type | Practitioner - Hospitalist |
Provider Identifiers | NPI Number: 1104181304 PECOS PAC ID: 7315259991 Enrollment ID: I20150710000519 |
Provider Name | Brad John Rohr |
---|---|
Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1407196975 PECOS PAC ID: 3779721386 Enrollment ID: I20151022002328 |
Provider Name | Rebecca J Konen |
---|---|
Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1386949337 PECOS PAC ID: 3870776289 Enrollment ID: I20151026000413 |
Provider Name | Jennifer Gene Kingery |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1982074332 PECOS PAC ID: 9032429733 Enrollment ID: I20151109002526 |
Provider Name | Mark R Martens |
---|---|
Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1194921973 PECOS PAC ID: 7315236833 Enrollment ID: I20160523000750 |
Provider Name | Nathaniel J Slinkard |
---|---|
Provider Type | Practitioner - Orthopedic Surgery |
Provider Identifiers | NPI Number: 1396037651 PECOS PAC ID: 6305078478 Enrollment ID: I20160616001862 |
Provider Name | Katherine F Reigstad |
---|---|
Provider Type | Practitioner - Vascular Surgery |
Provider Identifiers | NPI Number: 1386872539 PECOS PAC ID: 8527290261 Enrollment ID: I20160803002188 |
Provider Name | Ashley M Hieronimus |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1780959148 PECOS PAC ID: 7517262850 Enrollment ID: I20160916000257 |
Provider Name | Kendra C Lund |
---|---|
Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1639622335 PECOS PAC ID: 4183911431 Enrollment ID: I20160929002098 |
Provider Name | Michael R Enrico |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1912960006 PECOS PAC ID: 5698709848 Enrollment ID: I20161003002134 |
Provider Name | Alicia Grace Floyd |
---|---|
Provider Type | Practitioner - Hospitalist |
Provider Identifiers | NPI Number: 1033408505 PECOS PAC ID: 2567680713 Enrollment ID: I20170814001669 |
Provider Name | Samantha Jaimee Ganick |
---|---|
Provider Type | Practitioner - Urology |
Provider Identifiers | NPI Number: 1447420427 PECOS PAC ID: 2163695735 Enrollment ID: I20170921002773 |
Provider Name | Terri Jo Malecek |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1366539363 PECOS PAC ID: 0244395598 Enrollment ID: I20171031001575 |
Provider Name | Amy L Vanhorne |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1457749426 PECOS PAC ID: 5991022477 Enrollment ID: I20171101000193 |
Provider Name | Jonathan Aurelio Silva |
---|---|
Provider Type | Practitioner - Anesthesiology |
Provider Identifiers | NPI Number: 1023303245 PECOS PAC ID: 4486944535 Enrollment ID: I20171130000323 |
Provider Name | Alexandra L Malkuch |
---|---|
Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1689186207 PECOS PAC ID: 3476813668 Enrollment ID: I20180208000622 |
Provider Name | Stephanie Vogel |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1720590524 PECOS PAC ID: 1951663350 Enrollment ID: I20180323000377 |
Provider Name | Bailey A Dykema |
---|---|
Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1942717046 PECOS PAC ID: 2769744069 Enrollment ID: I20180327000473 |
Provider Name | Tory Lynn Brouwer |
---|---|
Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1760830889 PECOS PAC ID: 0244511830 Enrollment ID: I20180525000148 |
Provider Name | Daniel B Pickett |
---|---|
Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1174866644 PECOS PAC ID: 9133475478 Enrollment ID: I20180628003150 |
Provider Name | Brandon L Tucker |
---|---|
Provider Type | Practitioner - Podiatry |
Provider Identifiers | NPI Number: 1598142457 PECOS PAC ID: 4183970262 Enrollment ID: I20180703000113 |
Provider Name | Damon M Campbell |
---|---|
Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1518285816 PECOS PAC ID: 3375771744 Enrollment ID: I20180716000172 |
Provider Name | Lee M Haggenjos |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1003207416 PECOS PAC ID: 6709144892 Enrollment ID: I20180801002195 |
Provider Name | Jacob B Dubay |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1831514686 PECOS PAC ID: 2769758895 Enrollment ID: I20180806002971 |
Provider Name | Ryan Michael Finn |
---|---|
Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1558898684 PECOS PAC ID: 7810269008 Enrollment ID: I20180806003180 |
Provider Name | Anna L Leitch |
---|---|
Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
Provider Identifiers | NPI Number: 1790270148 PECOS PAC ID: 9931457033 Enrollment ID: I20180807000244 |
Provider Name | Jaclyn A Johnson |
---|---|
Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
Provider Identifiers | NPI Number: 1811488430 PECOS PAC ID: 3971851072 Enrollment ID: I20180807000581 |
Provider Name | Gabriel A Fierro-fine |
---|---|
Provider Type | Practitioner - Anesthesiology |
Provider Identifiers | NPI Number: 1700223146 PECOS PAC ID: 2365711660 Enrollment ID: I20181016000723 |
Provider Name | Sarah Myers |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1043785199 PECOS PAC ID: 2668726456 Enrollment ID: I20181114001061 |
Provider Name | Nayera Rafik Attalla Guirguis |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1023334752 PECOS PAC ID: 2466761606 Enrollment ID: I20190228002168 |
Provider Name | Natalie K Mathiowetz |
---|---|
Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
Provider Identifiers | NPI Number: 1952861809 PECOS PAC ID: 7012259666 Enrollment ID: I20190430002527 |
Provider Name | Gavin J Maurer |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1164955621 PECOS PAC ID: 4284976895 Enrollment ID: I20190501001696 |
Provider Name | Adewale O Odofin |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1972955375 PECOS PAC ID: 3375876899 Enrollment ID: I20190614000699 |
Provider Name | Stephanie J Johanneck |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1891355913 PECOS PAC ID: 6507191053 Enrollment ID: I20190705001197 |
Provider Name | Sakshi Kaul |
---|---|
Provider Type | Practitioner - Physical Medicine And Rehabilitation |
Provider Identifiers | NPI Number: 1184044067 PECOS PAC ID: 6305141169 Enrollment ID: I20191002000804 |
Provider Name | Meagan A Hoflock |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1811526403 PECOS PAC ID: 5294165767 Enrollment ID: I20200423002638 |
Provider Name | Wade E Paulson |
---|---|
Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1447645916 PECOS PAC ID: 1355656984 Enrollment ID: I20200526000075 |
Provider Name | Justin P Stocks |
---|---|
Provider Type | Practitioner - Pulmonary Disease |
Provider Identifiers | NPI Number: 1811124837 PECOS PAC ID: 0547446361 Enrollment ID: I20200707001585 |
Provider Name | Robert George Johnson |
---|---|
Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1891182341 PECOS PAC ID: 0648584664 Enrollment ID: I20200903000244 |
Provider Name | Tyler G Goettl |
---|---|
Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1205213881 PECOS PAC ID: 3971809484 Enrollment ID: I20201005000621 |
Provider Name | Ann E Johnson |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1205299385 PECOS PAC ID: 5294026720 Enrollment ID: I20201014003072 |
Provider Name | Khalid M Sonbol |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1750796629 PECOS PAC ID: 3476778242 Enrollment ID: I20201020002594 |
Provider Name | Traci J Salveson |
---|---|
Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1407467749 PECOS PAC ID: 2466862180 Enrollment ID: I20201109003260 |
Provider Name | Crystal L Fleischhacker |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1356956601 PECOS PAC ID: 5698187185 Enrollment ID: I20201207000657 |
Provider Name | Tyler J Brower |
---|---|
Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1891399978 PECOS PAC ID: 7214349141 Enrollment ID: I20201216002944 |
Provider Name | Amber Erin Johnson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1003459629 PECOS PAC ID: 0244657351 Enrollment ID: I20210127001706 |
Provider Name | Syed Haris Ali |
---|---|
Provider Type | Practitioner - Hospitalist |
Provider Identifiers | NPI Number: 1033598214 PECOS PAC ID: 7416283932 Enrollment ID: I20210202000754 |
Provider Name | Richard E Belmont |
---|---|
Provider Type | Practitioner - Anesthesiology |
Provider Identifiers | NPI Number: 1013919968 PECOS PAC ID: 8921182379 Enrollment ID: I20210311002633 |
Provider Name | Sasan Moshirzadeh |
---|---|
Provider Type | Practitioner - Neurology |
Provider Identifiers | NPI Number: 1689023186 PECOS PAC ID: 3173815867 Enrollment ID: I20210521000035 |
Provider Name | Nicole J Carbert |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1578138020 PECOS PAC ID: 9234532904 Enrollment ID: I20210720000433 |
Provider Name | Kathleen M Wesa |
---|---|
Provider Type | Practitioner - Hospitalist |
Provider Identifiers | NPI Number: 1114965597 PECOS PAC ID: 1254420318 Enrollment ID: I20210729002102 |
Provider Name | Courtney M Klinkhammer |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1609371939 PECOS PAC ID: 6608129820 Enrollment ID: I20210806000006 |
Provider Name | Shaun M Seaburg |
---|---|
Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1467036269 PECOS PAC ID: 6507260957 Enrollment ID: I20210806000220 |
Provider Name | Oluwatobi O Falade |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1447813431 PECOS PAC ID: 6800121971 Enrollment ID: I20210813001330 |
Provider Name | Gamaliel Jesse Ferrer |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1912460734 PECOS PAC ID: 1759616865 Enrollment ID: I20210813003033 |
Provider Name | Robert H Krieger |
---|---|
Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1912367103 PECOS PAC ID: 0143625749 Enrollment ID: I20210819002716 |
Provider Name | Laurel L Wessman |
---|---|
Provider Type | Practitioner - Dermatology |
Provider Identifiers | NPI Number: 1922510163 PECOS PAC ID: 0345585709 Enrollment ID: I20210902002137 |
Provider Name | Anna R Fuglestad |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1518463983 PECOS PAC ID: 4981956265 Enrollment ID: I20210914002497 |
Provider Name | Laura B Mcdowell |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1578099107 PECOS PAC ID: 0648540864 Enrollment ID: I20210916001443 |
Provider Name | Dennis S Guadarrama |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1619350402 PECOS PAC ID: 2365870607 Enrollment ID: I20210927001879 |
Provider Name | Bethany J Wendlandt |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1134898422 PECOS PAC ID: 4183022742 Enrollment ID: I20211012001787 |
Provider Name | Lindsey M Beckman |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1013686955 PECOS PAC ID: 9830587047 Enrollment ID: I20211020002024 |
Provider Name | Sarah H Christianson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1477217339 PECOS PAC ID: 4082004403 Enrollment ID: I20211129001702 |
Provider Name | Bonnie M Henry |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1649922402 PECOS PAC ID: 9436544178 Enrollment ID: I20220316003189 |
Provider Name | Seth D Nelson |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1679193957 PECOS PAC ID: 4486076973 Enrollment ID: I20220718001182 |
Provider Name | Courtney A Bothun |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1700515582 PECOS PAC ID: 9931580834 Enrollment ID: I20220725001199 |
Provider Name | Abdikafar M Yusuf |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1366935363 PECOS PAC ID: 4385067503 Enrollment ID: I20220818002946 |
Provider Name | Kyle E Rudningen |
---|---|
Provider Type | Practitioner - Dermatology |
Provider Identifiers | NPI Number: 1194248013 PECOS PAC ID: 8628326592 Enrollment ID: I20220819002264 |
Provider Name | Wesley J Halseth |
---|---|
Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1891227971 PECOS PAC ID: 3678844867 Enrollment ID: I20220921002720 |
Provider Name | Sarah Margaret Campbell |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1538789631 PECOS PAC ID: 6709200371 Enrollment ID: I20221010001075 |
Provider Name | Diana F Niblack |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1275255721 PECOS PAC ID: 7315314887 Enrollment ID: I20221115000085 |
Provider Name | Desmond Jy Wah |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1366673568 PECOS PAC ID: 5496901787 Enrollment ID: I20221207002883 |
Provider Name | Kristen A Williamson |
---|---|
Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
Provider Identifiers | NPI Number: 1104547793 PECOS PAC ID: 8426427782 Enrollment ID: I20221207002923 |
Provider Name | Laurie Claussen O'leary |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1619286184 PECOS PAC ID: 2961681838 Enrollment ID: I20221209001612 |
Provider Name | Sarah E Lechner |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1548977267 PECOS PAC ID: 4981074648 Enrollment ID: I20221221003044 |
Provider Name | Cassandra R Jackson |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1053998781 PECOS PAC ID: 7517369309 Enrollment ID: I20230103000017 |
Provider Name | Megan Ann Woller |
---|---|
Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1801500400 PECOS PAC ID: 1153792205 Enrollment ID: I20230127000781 |
Provider Name | Dwijesh S Sheth |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1134758576 PECOS PAC ID: 6901223262 Enrollment ID: I20230209002002 |
Provider Name | Robert Imel |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1154850592 PECOS PAC ID: 2062764848 Enrollment ID: I20230527000198 |
Provider Name | Rose Erickson |
---|---|
Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
Provider Identifiers | NPI Number: 1154005130 PECOS PAC ID: 4284093790 Enrollment ID: I20230630001929 |
Provider Name | Christopher Odens |
---|---|
Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
Provider Identifiers | NPI Number: 1386321651 PECOS PAC ID: 6800240839 Enrollment ID: I20230926000643 |
Provider Name | Samantha Wetzel |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1750166500 PECOS PAC ID: 3375991748 Enrollment ID: I20231122003007 |
Provider Name | Nicholas Teneyuque |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1790002376 PECOS PAC ID: 4688056682 Enrollment ID: I20231122003013 |
Provider Name | Melissa Christine Bray-iverslie |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1801660881 PECOS PAC ID: 7012368467 Enrollment ID: I20240110001143 |
Provider Name | Emma Sheforgen |
---|---|
Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
Provider Identifiers | NPI Number: 1184481418 PECOS PAC ID: 8123466729 Enrollment ID: I20240402001481 |
Provider Name | Jennifer Schmitz |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1295312049 PECOS PAC ID: 7810306735 Enrollment ID: I20240510002529 |
Provider Name | Marc Fernandez |
---|---|
Provider Type | Practitioner - General Surgery |
Provider Identifiers | NPI Number: 1972571727 PECOS PAC ID: 9638137839 Enrollment ID: I20240613000805 |
West Central Solutions, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 414 Becker Ave Sw Ste 1a, Willmar, MN 56201 Phone: 612-814-7840 | |
Community Health Service Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1804 Trott Ave Sw, Willmar, MN 56201 Phone: 320-214-7286 Fax: 320-214-7223 | |
Gillette Children's Healthcare Willmar Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1303 1st St S Ste 1, Willmar, MN 56201 Phone: 651-634-1938 | |
Carris Health Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 101 Willmar Ave Sw, Willmar, MN 56201 Phone: 320-231-5000 | |
Pearle Vision Willmar Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2404 1st St S, Willmar, MN 56201 Phone: 320-235-1235 Fax: 320-235-9241 | |
Miller Chiropractic Office Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1804 Trott Ave Sw, Willmar, MN 56201 Phone: 320-235-0880 |