BRAINERD MEDICAL CENTER INC — NPI 1053342329 (Licensed & Credentialed Suppliers — Pharmacy, Clinic Pharmacy in BRAINERD, MN)

CMS-1500 Box 24J / 33a • NPI

1053342329

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

3336C0002X (CMS 58)

Licensed & Credentialed Suppliers — Pharmacy, Clinic Pharmacy

Box 32 Service Location & ZIP+4

2024 S 6TH ST, BRAINERD, MN, 56401-4529

✓ 9-Digit EDI 837 ZIP+4 (56401-4529)

Practice Phone & Referral Fax

(218) 829-7455

Fax: (218) 855-5205

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1053342329 (BRAINERD MEDICAL CENTER INC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1053342329` (NPI-2 Organization / Facility)
Provider / Legal Name	BRAINERD MEDICAL CENTER INC
Plain-English Specialty	Licensed & Credentialed Suppliers — Pharmacy, Clinic Pharmacy NUCC Code: `3336C0002X` (Pharmacy, Clinic Pharmacy)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	2024 S 6TH ST, BRAINERD, MN, 56401-4529
Practice Telephone / Fax	Tel: (218) 829-7455 \| Fax: (218) 855-5205
Administrative Mailing Address	204 BELKNAP ST, SUPERIOR, WI, 54880-2905
Enumeration & Last Sync	Enumerated: 2006-07-05 \| CMS Record Updated: 2024-02-23
Authorized Official	KEVIN BOREN (VP of Finance)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

2024 S 6TH ST, BRAINERD, MN, 56401-4529

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Plain-English Taxonomy & CMS Crosswalk (3336C0002X)

What Does Taxonomy Code 3336C0002X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 3336C0002X translates to:
"Licensed & Credentialed Suppliers — Pharmacy, Clinic Pharmacy"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 58 (Medical Supply Company with Pharmacist) • CMS Code A5 (Pharmacy)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Pharmacy, Clinic Pharmacy for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (BRAINERD MEDICAL CENTER INC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`3336C0002X` — Pharmacy, Clinic Pharmacy Plain English: Licensed & Credentialed Suppliers — Pharmacy, Clinic Pharmacy	State: MN \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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BRAINERD MEDICAL CENTER INC (NPI #1053342329)