Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Samuel Thomas Goracke, CNP

Individual provider Internal Medicine Physician · NPI 1144905159

Samuel Thomas Goracke, CNP is a Nurse Practitioner in St Louis Park, Minnesota. Qualified in 2023, 3 years ago. Practices with Glacial Ridge Hospital District, a 69-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
3
Licensed in
MN
In the registry since
2023
Specialties on file
2
What do these letters mean?
CNP — Certified Nurse Practitioner
A certified nurse practitioner.

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Practice location Address checks out

6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Phone: (320) 424-0570
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 640 Jackson St, Saint Paul, MN 55101-2502 — (320) 424-0570

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 10717 (MN)
Internal Medicine Physician Taxonomy 207R00000X · Licence 00000000 (MN)

Record details

NPI number1144905159
Entity typeIndividual (Type 1)
GenderMale
Credentials CNP
Sole proprietorNo
NPI enumeratedJune 19, 2023
Last updated in NPPESSeptember 27, 2023
Certification dateSeptember 27, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Glacial Ridge Hospital District — 69 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Other providers in St Louis Park