<unavail> in Minneapolis, MN - Medicare Clinic/Center

is a medicare enrolled primary clinic (Clinic/center) in Minneapolis, Minnesota. The current practice location for is 720 W Lake St Ste 105, Minneapolis, Minnesota. For appointments, you can reach them via phone at (612) 388-9124. The mailing address for is 720 W Lake St Ste 105, Minneapolis, Minnesota and phone number is () -.

is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its NPI number is 1437892403. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (612) 388-9124.

Contact Information


	720 W Lake St Ste 105 Minneapolis MN 55408-2963
	(612) 388-9124
	Not Available

Map and Direction

Primary Care Clinic Profile

Full Name
Speciality	Clinic/Center
Location	720 W Lake St Ste 105, Minneapolis, Minnesota
Authorized Official Name and Position	Amir Mohamed (BOARD MEMBER)
Authorized Official Contact	6123889124
Accepts Medicare Insurance	Yes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
720 W Lake St Ste 105 Minneapolis MN 55408-2963 Ph: () -	720 W Lake St Ste 105 Minneapolis MN 55408-2963 Ph: (612) 388-9124

NPI Details:

NPI Number	1437892403
Provider Enumeration Date	04/18/2022
Last Update Date	11/22/2024

Medicare PECOS Information:

Medicare PECOS PAC ID	9335519891
Medicare Enrollment ID	O20221228001810

Medical Identifiers

Medical identifiers for such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1437892403	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
261Q00000X	Clinic/center	(* (Not Available))	Primary
261QM0801X	Clinic/center - Mental Health (including Community Mental Health Center)	(* (Not Available))	Secondary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. acts as a billing entity for following providers:

Provider Name	Mardiya K Jaffer
Provider Type	Practitioner - Nurse Practitioner
Provider Identifiers	NPI Number: 1215436076 PECOS PAC ID: 1254695042 Enrollment ID: I20180502001710

Provider Name	Miteku Tezera Desalgne
Provider Type	Practitioner - Nurse Practitioner
Provider Identifiers	NPI Number: 1164028296 PECOS PAC ID: 8820471899 Enrollment ID: I20220824001667

Provider Name	Shirlynn Mc Neil La Chapelle
Provider Type	Practitioner - Nurse Practitioner
Provider Identifiers	NPI Number: 1306593710 PECOS PAC ID: 4385179779 Enrollment ID: I20241121003175

Reviews and Comments

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- Medicare Primary Care in Minneapolis, MN