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2001 Bloomington Ave Minneapolis MN 55404-3074 | |
| (612) 301-3433 | |
| (612) 627-4205 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 2001 Bloomington Ave, Minneapolis, Minnesota |
| Authorized Official Name and Position | Colleen Mcdonald-diouf (CEO) |
| Authorized Official Contact | 6123010698 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2001 Bloomington Ave Minneapolis MN 55404-3074 Ph: (612) 301-3433 | 2001 Bloomington Ave Minneapolis MN 55404-3074 Ph: (612) 301-3433 |
| NPI Number | 1114019858 |
|---|---|
| Provider Enumeration Date | 09/29/2006 |
| Last Update Date | 05/09/2017 |
| Medicare PECOS PAC ID | 7416856059 |
|---|---|
| Medicare Enrollment ID | O20040102000679 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114019858 | NPI | - | NPPES |
| 855553200 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 855553200 (Minnesota) | Primary |
| Provider Name | Carolyn S Oeltjenbruns |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215992771 PECOS PAC ID: 9830089762 Enrollment ID: I20040316000916 |
| Provider Name | Cory Herman |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1588765754 PECOS PAC ID: 7012909047 Enrollment ID: I20040331000895 |
| Provider Name | Michelle I Ansorge |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255402319 PECOS PAC ID: 2264425115 Enrollment ID: I20040406001042 |
| Provider Name | Saghar Shafizadeh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1861422198 PECOS PAC ID: 7315930617 Enrollment ID: I20040414000763 |
| Provider Name | Bruce J Anderson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497783955 PECOS PAC ID: 0042293243 Enrollment ID: I20040609000911 |
| Provider Name | Jennifer A Krzmarzick |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659443182 PECOS PAC ID: 9638149388 Enrollment ID: I20040729000493 |
| Provider Name | James Q Swift |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1255304507 PECOS PAC ID: 3971570623 Enrollment ID: I20040913001163 |
| Provider Name | Karen E Jankowski |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972539625 PECOS PAC ID: 6507829793 Enrollment ID: I20041109000519 |
| Provider Name | Eleonore T Okosdinossian |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427076033 PECOS PAC ID: 9830152743 Enrollment ID: I20041110001057 |
| Provider Name | Max P Hergott |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1649341702 PECOS PAC ID: 3971569401 Enrollment ID: I20041207000523 |
| Provider Name | Mansur Ahmad |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1235281502 PECOS PAC ID: 7012967680 Enrollment ID: I20050201000101 |
| Provider Name | Rajaram Gopalakrishnan |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1134230022 PECOS PAC ID: 8325095540 Enrollment ID: I20050331000229 |
| Provider Name | Constance A Bromaghim |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1891868642 PECOS PAC ID: 4082654397 Enrollment ID: I20050505000993 |
| Provider Name | Jonathan D Kirsch |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336184464 PECOS PAC ID: 3870538788 Enrollment ID: I20050622000161 |
| Provider Name | Jared M Frandson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902856404 PECOS PAC ID: 5496786279 Enrollment ID: I20050823000050 |
| Provider Name | Steven A Anderson Hermann |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1922179456 PECOS PAC ID: 0244261766 Enrollment ID: I20050824001052 |
| Provider Name | Debra A Baik |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1982668786 PECOS PAC ID: 2264465863 Enrollment ID: I20050914000806 |
| Provider Name | Lisa M Bowman |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1861479065 PECOS PAC ID: 2567495898 Enrollment ID: I20050916000032 |
| Provider Name | Christopher J Reif |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164435525 PECOS PAC ID: 0042244840 Enrollment ID: I20050921000679 |
| Provider Name | Emily K Kahnert |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1063438216 PECOS PAC ID: 8123052495 Enrollment ID: I20050926000737 |
| Provider Name | Matthew J Karban |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1174501092 PECOS PAC ID: 6507883733 Enrollment ID: I20051027000591 |
| Provider Name | Charles K Kim |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700854411 PECOS PAC ID: 1850353814 Enrollment ID: I20060125000280 |
| Provider Name | Mark I Holub |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720038714 PECOS PAC ID: 0749294635 Enrollment ID: I20060131000105 |
| Provider Name | Christopher J Pensinger |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285671644 PECOS PAC ID: 4082621040 Enrollment ID: I20060315000699 |
| Provider Name | Quentin M Gabor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427115856 PECOS PAC ID: 6002883139 Enrollment ID: I20060323000136 |
| Provider Name | John G Schipke |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215967815 PECOS PAC ID: 3375551989 Enrollment ID: I20060323000342 |
| Provider Name | Patricia L Weber |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1992840276 PECOS PAC ID: 5496763534 Enrollment ID: I20060330000501 |
| Provider Name | Michael S Broton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518976893 PECOS PAC ID: 7214930312 Enrollment ID: I20060810000141 |
| Provider Name | Michael J Aylward |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053366575 PECOS PAC ID: 0547263600 Enrollment ID: I20060810000568 |
| Provider Name | Mary M Benbenek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487608642 PECOS PAC ID: 1850399510 Enrollment ID: I20061114000122 |
| Provider Name | Margaret A Belew |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1366529778 PECOS PAC ID: 0446259188 Enrollment ID: I20061207000185 |
| Provider Name | Michele L Allen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033153200 PECOS PAC ID: 1153321542 Enrollment ID: I20070109000367 |
| Provider Name | Ioannis G Koutlas |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1447361332 PECOS PAC ID: 7719084391 Enrollment ID: I20070515000570 |
| Provider Name | Mike T John |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1386865814 PECOS PAC ID: 1153429766 Enrollment ID: I20070605000680 |
| Provider Name | Patricia A Rake |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1730255134 PECOS PAC ID: 5496856338 Enrollment ID: I20070723000570 |
| Provider Name | Sarah C Kelley-pegg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780883256 PECOS PAC ID: 5799877494 Enrollment ID: I20070827000298 |
| Provider Name | Jennifer R Smithkristensen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194791756 PECOS PAC ID: 0446158752 Enrollment ID: I20080410000503 |
| Provider Name | Scott A Rake |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1851454334 PECOS PAC ID: 0143387423 Enrollment ID: I20090401000291 |
| Provider Name | Donald R Nixdorf |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1538211727 PECOS PAC ID: 0941357818 Enrollment ID: I20090409000661 |
| Provider Name | Sue Y Park |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417999491 PECOS PAC ID: 5698664662 Enrollment ID: I20091012000378 |
| Provider Name | Roli Dwivedi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629258751 PECOS PAC ID: 5890834402 Enrollment ID: I20091119000683 |
| Provider Name | Michael K Popkin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1326054388 PECOS PAC ID: 1557265139 Enrollment ID: I20100420000069 |
| Provider Name | Marie E Idelkope |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1144352873 PECOS PAC ID: 2567591209 Enrollment ID: I20100518000921 |
| Provider Name | Neelu K Hira |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1164417325 PECOS PAC ID: 2860523651 Enrollment ID: I20100622000851 |
| Provider Name | Christine J Janty |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1710058243 PECOS PAC ID: 5092839365 Enrollment ID: I20100824000899 |
| Provider Name | Iris W Borowsky |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1174569396 PECOS PAC ID: 1658563903 Enrollment ID: I20101005001336 |
| Provider Name | Abby M Bathke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487968533 PECOS PAC ID: 1355537630 Enrollment ID: I20101129000718 |
| Provider Name | Rebecca I Skoler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720149834 PECOS PAC ID: 2860673852 Enrollment ID: I20110224000032 |
| Provider Name | Jeremy A Goldberg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013243708 PECOS PAC ID: 6204012040 Enrollment ID: I20110512000454 |
| Provider Name | Deborah K Johnson |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1134113764 PECOS PAC ID: 3971789363 Enrollment ID: I20110519000557 |
| Provider Name | Margaret M Hilgemann |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154478311 PECOS PAC ID: 8325224561 Enrollment ID: I20110524000036 |
| Provider Name | Cuong Q Pham |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790970341 PECOS PAC ID: 6305014994 Enrollment ID: I20110726000787 |
| Provider Name | Erin A Bodner |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1942588298 PECOS PAC ID: 2769654292 Enrollment ID: I20111005000739 |
| Provider Name | Elizabeth Je Rattner |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1629216247 PECOS PAC ID: 9436310828 Enrollment ID: I20120411000600 |
| Provider Name | Shanti Kaimal |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1124385018 PECOS PAC ID: 0749446730 Enrollment ID: I20120718000949 |
| Provider Name | Alicia A Grund |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013356088 PECOS PAC ID: 2062655921 Enrollment ID: I20130826000634 |
| Provider Name | Priya Kamdar |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1598050627 PECOS PAC ID: 8628202637 Enrollment ID: I20131007000670 |
| Provider Name | Elizabeth A Rogers |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538369749 PECOS PAC ID: 1355529447 Enrollment ID: I20131113002205 |
| Provider Name | Abigail E Rossing |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376975482 PECOS PAC ID: 2668608209 Enrollment ID: I20131204000143 |
| Provider Name | Jennifer B Beldon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336292390 PECOS PAC ID: 2062641566 Enrollment ID: I20140203001360 |
| Provider Name | Ryan Kelly |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881820074 PECOS PAC ID: 0446475495 Enrollment ID: I20140707000823 |
| Provider Name | Mary T Odonnell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598778953 PECOS PAC ID: 7416271010 Enrollment ID: I20150129001924 |
| Provider Name | Angela D Sarkissian |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134359888 PECOS PAC ID: 2163672015 Enrollment ID: I20150220002209 |
| Provider Name | Cecilia Campos Bloomquist |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154671147 PECOS PAC ID: 7416273933 Enrollment ID: I20150227001392 |
| Provider Name | Brooke Ayoka Cunningham |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093980013 PECOS PAC ID: 6901092030 Enrollment ID: I20150302000268 |
| Provider Name | Estephan J Moana-filho |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1306245329 PECOS PAC ID: 8123345808 Enrollment ID: I20150317001324 |
| Provider Name | Dawn M Brintnell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235538547 PECOS PAC ID: 7719204619 Enrollment ID: I20150401001927 |
| Provider Name | Stephanie L Wetzel |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1528217940 PECOS PAC ID: 7315265543 Enrollment ID: I20150417001542 |
| Provider Name | Mary W Clark |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720127988 PECOS PAC ID: 7214913060 Enrollment ID: I20150602002837 |
| Provider Name | Rebecca Ml Lulai |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1982890133 PECOS PAC ID: 8325369747 Enrollment ID: I20150610000601 |
| Provider Name | Calla R Brown |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134411283 PECOS PAC ID: 8123330065 Enrollment ID: I20150706002316 |
| Provider Name | Ronald A Curran |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1790870392 PECOS PAC ID: 6103134432 Enrollment ID: I20151006001100 |
| Provider Name | Robert A Nadeau |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1881620771 PECOS PAC ID: 3971769035 Enrollment ID: I20151020001974 |
| Provider Name | Megan Leigh Smith |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336430453 PECOS PAC ID: 0941425003 Enrollment ID: I20151021001603 |
| Provider Name | Keith A Mays |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1639437163 PECOS PAC ID: 5193035814 Enrollment ID: I20151110001031 |
| Provider Name | Kerry L Witherell |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1790971695 PECOS PAC ID: 7416046446 Enrollment ID: I20151112001460 |
| Provider Name | Jason R Burgart |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1508030412 PECOS PAC ID: 2961712427 Enrollment ID: I20151112002116 |
| Provider Name | Harold Kai Tu |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1942398797 PECOS PAC ID: 0345214664 Enrollment ID: I20151124000449 |
| Provider Name | James P Suchy |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1659458065 PECOS PAC ID: 9739489568 Enrollment ID: I20151201002142 |
| Provider Name | Suganya Ava Appugounder |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1689801771 PECOS PAC ID: 1254632920 Enrollment ID: I20151222002174 |
| Provider Name | Joseph D Schoess |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1205184306 PECOS PAC ID: 3274784160 Enrollment ID: I20151224000029 |
| Provider Name | Esther C Mckeown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790877124 PECOS PAC ID: 8325341597 Enrollment ID: I20160121001290 |
| Provider Name | Andrea N King |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1447615885 PECOS PAC ID: 6002110632 Enrollment ID: I20160202001781 |
| Provider Name | Daya Srinivasan |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1548502206 PECOS PAC ID: 8224331707 Enrollment ID: I20160309002424 |
| Provider Name | Aarti D Bhatt |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396005617 PECOS PAC ID: 8921391897 Enrollment ID: I20160729001452 |
| Provider Name | Natalie N. Jacobson-dunlop |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1598934689 PECOS PAC ID: 2961687330 Enrollment ID: I20170303000141 |
| Provider Name | Marilyn E Fairchild |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1346436839 PECOS PAC ID: 7214212463 Enrollment ID: I20170330001244 |
| Provider Name | Ann Laros |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1619964277 PECOS PAC ID: 1254387624 Enrollment ID: I20170608002242 |
| Provider Name | Tudor I Stiharu |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1265728299 PECOS PAC ID: 8224307772 Enrollment ID: I20170627001630 |
| Provider Name | Jonathan C Homans |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1588919526 PECOS PAC ID: 6709192313 Enrollment ID: I20170814000409 |
| Provider Name | James K Zenk |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1952492035 PECOS PAC ID: 3173828498 Enrollment ID: I20171003007212 |
| Provider Name | Michael C Raguet |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992216188 PECOS PAC ID: 8527325547 Enrollment ID: I20171130000002 |
| Provider Name | Andrea C Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043720824 PECOS PAC ID: 3779840343 Enrollment ID: I20171206003372 |
| Provider Name | Carly Jean Cauley |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1598278889 PECOS PAC ID: 0840558607 Enrollment ID: I20171227002314 |
| Provider Name | Rachel M Uppgaard |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1447517941 PECOS PAC ID: 8628365558 Enrollment ID: I20180109000791 |
| Provider Name | Shaeleen M Fagre |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1902054331 PECOS PAC ID: 1557498821 Enrollment ID: I20180111000752 |
| Provider Name | Anna M Vangsness |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669821708 PECOS PAC ID: 3870855562 Enrollment ID: I20180316000362 |
| Provider Name | Laurence R Gaalaas |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1467834259 PECOS PAC ID: 2466717871 Enrollment ID: I20180605001710 |
| Provider Name | Paul S Olin |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1619011962 PECOS PAC ID: 4880593433 Enrollment ID: I20180811000023 |
| Provider Name | Lan Parker Luu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033520986 PECOS PAC ID: 4183920168 Enrollment ID: I20180827002991 |
| Provider Name | Daniel Robert Mcalvin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629373964 PECOS PAC ID: 1759631609 Enrollment ID: I20180913002665 |
| Provider Name | Sadiya S Bule |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154876233 PECOS PAC ID: 6709138522 Enrollment ID: I20181005001811 |
| Provider Name | Morgan Lm Weinert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689159360 PECOS PAC ID: 7012251994 Enrollment ID: I20181204000547 |
| Provider Name | Andre Peri |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1982988259 PECOS PAC ID: 3375882640 Enrollment ID: I20190304001784 |
| Provider Name | Soukthanome X Thammavong |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164986246 PECOS PAC ID: 4688914047 Enrollment ID: I20190321000408 |
| Provider Name | Joshua N Larson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952955320 PECOS PAC ID: 6103156690 Enrollment ID: I20190926000276 |
| Provider Name | Kristin Alecia Verhoeven |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659923688 PECOS PAC ID: 0840520045 Enrollment ID: I20191002000858 |
| Provider Name | Melissa Moy Chin |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1730721895 PECOS PAC ID: 3173956786 Enrollment ID: I20191211002134 |
| Provider Name | Coralie A Pederson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841283074 PECOS PAC ID: 1759718349 Enrollment ID: I20200220000700 |
| Provider Name | Rahel Nardos |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1912111592 PECOS PAC ID: 6103999354 Enrollment ID: I20200603002776 |
| Provider Name | Lauren E Mcpherson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912439985 PECOS PAC ID: 5890067631 Enrollment ID: I20201208001492 |
| Provider Name | Emily Ann Bail |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447879119 PECOS PAC ID: 2961815535 Enrollment ID: I20201229001477 |
| Provider Name | Derek Steven Otte |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497361711 PECOS PAC ID: 4385050640 Enrollment ID: I20210310002966 |
| Provider Name | David L Basi |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1104898626 PECOS PAC ID: 2365419074 Enrollment ID: I20210512000597 |
| Provider Name | Krista Jean Lill |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1417418690 PECOS PAC ID: 2365879046 Enrollment ID: I20210715002776 |
| Provider Name | Michael Taurence Brooks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972171726 PECOS PAC ID: 5496158990 Enrollment ID: I20210721002331 |
| Provider Name | Tiffany Kaye Grunewald |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1265506513 PECOS PAC ID: 5597169474 Enrollment ID: I20210816000111 |
| Provider Name | Levi Zarbano |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1225458391 PECOS PAC ID: 2264839448 Enrollment ID: I20210930003106 |
| Provider Name | Vivian B Nguyen |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1932769510 PECOS PAC ID: 8921496761 Enrollment ID: I20211027000888 |
| Provider Name | Carrie Mae Slag |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1790868693 PECOS PAC ID: 3173912292 Enrollment ID: I20211111000977 |
| Provider Name | Sarah L Carlson-bradley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730859133 PECOS PAC ID: 2961893813 Enrollment ID: I20220103001526 |
| Provider Name | Athena M Diesch-chham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508359704 PECOS PAC ID: 7618368424 Enrollment ID: I20220104002398 |
| Provider Name | Jessica D Talamantes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760136709 PECOS PAC ID: 2062899396 Enrollment ID: I20220506000982 |
| Provider Name | Karen Rih Reh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619574258 PECOS PAC ID: 3375920788 Enrollment ID: I20220524001045 |
| Provider Name | Donald M Primley |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1003861865 PECOS PAC ID: 1254312945 Enrollment ID: I20221031002199 |
| Provider Name | Erika Arnold-mcewan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952679425 PECOS PAC ID: 5698902609 Enrollment ID: I20221123001381 |
| Provider Name | Christopher D Carvalho |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1659808079 PECOS PAC ID: 5698130458 Enrollment ID: I20230501000052 |
| Provider Name | Angela M Melland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427601483 PECOS PAC ID: 0840657326 Enrollment ID: I20230530001177 |
| Provider Name | Jeanette M Spanjers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831976661 PECOS PAC ID: 1254784473 Enrollment ID: I20240124001763 |
| Provider Name | Angie C Morillas Marini |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1700307022 PECOS PAC ID: 9234572348 Enrollment ID: I20240206001791 |
| Provider Name | Andrea Elena Caro |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1770344095 PECOS PAC ID: 5092014506 Enrollment ID: I20240215000935 |
| Provider Name | Safiya Nur Ahmed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992300370 PECOS PAC ID: 1052756962 Enrollment ID: I20240301001841 |
| Provider Name | Stephen K Shuman |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1376548313 PECOS PAC ID: 9739499468 Enrollment ID: I20240314000050 |
| Provider Name | Jake A Timian |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639605710 PECOS PAC ID: 9032555792 Enrollment ID: I20240315003016 |
| Provider Name | Andrew T Moe |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1568062461 PECOS PAC ID: 2062859796 Enrollment ID: I20240318001752 |
| Provider Name | Renie Daniel |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1265620504 PECOS PAC ID: 5496061921 Enrollment ID: I20240418000183 |
| Provider Name | Chih-yu Chen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1679156780 PECOS PAC ID: 2769882109 Enrollment ID: I20240521003331 |
| Provider Name | Abigail Samantha Moeller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336775220 PECOS PAC ID: 4082032818 Enrollment ID: I20240529002729 |
| Provider Name | Maria Angelica Prieto Cavalieri |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1366051658 PECOS PAC ID: 7911441605 Enrollment ID: I20240705001795 |
| Provider Name | Andrew Nguyen |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1275374316 PECOS PAC ID: 3870037492 Enrollment ID: I20240706000073 |
| Provider Name | Tyler John Varhol |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1003203498 PECOS PAC ID: 1254631823 Enrollment ID: I20240822000001 |
| Provider Name | Eileen Huttlin Kirtane |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154784098 PECOS PAC ID: 1557780020 Enrollment ID: I20241007001710 |
| Provider Name | Christopher John Vendel |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1407175326 PECOS PAC ID: 1456883354 Enrollment ID: I20241016004405 |
| Provider Name | William Charles Hanson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093533663 PECOS PAC ID: 8224560834 Enrollment ID: I20241021000260 |
| Provider Name | Kathryn Ede-imafidon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538991955 PECOS PAC ID: 0345772943 Enrollment ID: I20241021003951 |
| Provider Name | Matthew R Hanson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1699223651 PECOS PAC ID: 1052844438 Enrollment ID: I20241023002908 |
| Provider Name | Chee H Lee |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073155438 PECOS PAC ID: 4789117136 Enrollment ID: I20241024000738 |
| Provider Name | Winnie Yip |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134503493 PECOS PAC ID: 0547561896 Enrollment ID: I20241114003804 |
| Provider Name | Joy L Johnson-lind |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023398112 PECOS PAC ID: 1254866973 Enrollment ID: I20241119000143 |
| Provider Name | Nisha H Fernandes |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992062285 PECOS PAC ID: 4082911912 Enrollment ID: I20241119000202 |
| Provider Name | Grant E Raykowski |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1245223486 PECOS PAC ID: 0143755868 Enrollment ID: I20241119000258 |
| Provider Name | Rachel A Ans |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649647348 PECOS PAC ID: 3173058062 Enrollment ID: I20241202002706 |
| Provider Name | Rachel E Litecky |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538476791 PECOS PAC ID: 7618402413 Enrollment ID: I20241202003226 |
| Provider Name | Vaughn A Foster |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1194423657 PECOS PAC ID: 9032645098 Enrollment ID: I20241213001207 |
Morningstar Wellness Center, Ltd Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 800 Washington Ave N, Suite 202, Minneapolis, MN 55401 Phone: 612-455-2920 Fax: 612-455-2921 | |
Corban Health Care, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5141 36th Ave S, Minneapolis, MN 55417 Phone: 612-644-9047 | |
First Class Care Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1729 N 2nd St, Minneapolis, MN 55411 Phone: 952-270-5238 | |
Evernorth Care Providers - Delaware Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 121 Washington Ave N Fl 2, Minneapolis, MN 55401 Phone: 773-292-4800 Fax: 312-564-4059 |