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CENTRACARE - BIG LAKE CLINIC
NPI 1013104348
Clinic/Center - Multi-Specialty in Big Lake, MN

Active since October 01, 2007CLIA 24D1080211 · Waiver
16830 198TH AVE NW, CENTRACARE CLINIC - BIG LAKE, BIG LAKE, MN 55309(763) 263-7300(763) 263-7338 Get Directions Write a Review

NPPES record last updated: November 19, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Centracare - Big Lake Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CENTRACARE - BIG LAKE CLINIC (NPI 1013104348) is a healthcare organization registered as a multi-specialty in Big Lake, Minnesota and active in the NPI registry since October 2007. The organization holds a CLIA Waiver certificate valid through February 28, 2027 and lists Michael A Blair, Sr Vp & Cfo, as its authorized official.

NPPES Registry Identity

NPI1013104348
Entity TypeOrganization
Primary Taxonomy261QM1300X
Legal Business NameCENTRACARE CLINIC
Location Address16830 198TH AVE NW, CENTRACARE CLINIC - BIG LAKEBig Lake, MN 55309-4860
Mailing Address1200 6th Ave NSaint Cloud, MN 56303-2736 · (320) 229-4977 · Fax (763) 263-7338
Phone(763) 263-7300
Fax(763) 263-7338
Organization SubpartYes
Authorized OfficialMichael A BlairSr Vp & Cfo · (320) 255-5665
Enumeration DateOctober 1, 2007
Last NPPES UpdateNovember 19, 2020
NPPES CertifiedNovember 19, 2020
✔ NPI 1013104348 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Multi-SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM1300X
Also ListedDurable Medical Equipment & Medical SuppliesTaxonomy 332B00000X
16830 198TH AVE NW, Big Lake, MN 55309
Open in Google Maps ↗

Other Names 1

Doing Business AsCentracare - Big Lake Clinic

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include HealthPartners, Medica, Sanford Health Plan.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 24D1080211

Centracare - Big Lake · Big Lake, MN
Active · expires Feb 28, 2027
CLIA Number24D1080211
Laboratory TypePhysician Office
Certificate Effective DateMarch 1, 2025
Certificate Expiration DateFebruary 28, 2027
Laboratory DirectorBrian L. Mackenzii
Laboratory Phone(763) 271-2819
Laboratory LocationCentracare - Big Lake16830 198th Ave NW, Big Lake, MN 55309
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NABEEL BISHARA AILABOUNI DO
Family Medicine
16830 198TH AVE NW, BIG LAKE CLINIC
BIG LAKE, MN 55309
Sherburne County (763) 263-7300
LOLA B SUTHERLAND MD
Family Medicine
16830 198TH AVE NW, BIG LAKE CLINIC
BIG LAKE, MN 55309
Sherburne County (763) 263-7300
LUKE A. HERDINA P.A.-C
Physician Assistant (Medical)
16830 198TH AVE NW, BIG LAKE CLINIC
BIG LAKE, MN 55309
Sherburne County (763) 263-7300
GLENN W WEIDENBACHER MD
Pediatrics
16830 198TH AVE NW, BIG LAKE CLINIC
BIG LAKE, MN 55309
Sherburne County (763) 263-7300
FRESENIUS MEDICAL CARE CENTRACARE DIALYSIS, LLC
Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)
16830 198TH AVE NW
BIG LAKE, MN 55309
Sherburne County (763) 263-7320

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Centracare Clinic's NPI number?

The NPI number for Centracare Clinic is 1013104348. It was assigned to this organization in the NPPES registry on October 1, 2007. The provider is doing business as Centracare - Big Lake Clinic.

Where is Centracare Clinic located?

Centracare Clinic is located at 16830 198th Ave NW Centracare Clinic - Big Lake, Big Lake, MN 55309. The listed phone number is (763) 263-7300.

What is Centracare Clinic's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Multi-Specialty, with taxonomy code 261QM1300X.

Does Centracare Clinic hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D1080211) is associated with this NPI, valid through February 28, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Centracare Clinic accept?

Health plans from HealthPartners, Medica and Sanford Health Plan list Centracare Clinic as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Centracare Clinic was last updated on November 19, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.