| Southside Medical Clinic | |
|
324 E 35th St Minneapolis MN 55408-4580 | |
| (612) 827-7181 | |
| (612) 827-6403 |
| Full Name | Southside Medical Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 324 E 35th St, Minneapolis, Minnesota |
| Authorized Official Name and Position | Ann Cazaban (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6128212025 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southside Medical Clinic 4243 4th Ave S Minneapolis MN 55409-2113 Ph: (612) 821-2799 | Southside Medical Clinic 324 E 35th St Minneapolis MN 55408-4580 Ph: (612) 827-7181 |
| NPI Number | 1538137757 |
|---|---|
| Provider Enumeration Date | 03/14/2006 |
| Last Update Date | 07/10/2023 |
| Medicare PECOS PAC ID | 8921027228 |
|---|---|
| Medicare Enrollment ID | O20051116000311 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538137757 | NPI | - | NPPES |
| 343814700 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Ilene R Moore |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1659331445 PECOS PAC ID: 5991737454 Enrollment ID: I20050906000381 |
| Provider Name | Michelle E Taylor |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1528090420 PECOS PAC ID: 0840218814 Enrollment ID: I20051108000660 |
| Provider Name | Sofia M Ali |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851335194 PECOS PAC ID: 8921006883 Enrollment ID: I20061201000310 |
| Provider Name | Mark T Mcdermott |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1083680599 PECOS PAC ID: 9739284779 Enrollment ID: I20070419000235 |
| Provider Name | Meredith Walburg |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1538368113 PECOS PAC ID: 3274629076 Enrollment ID: I20101110001119 |
| Provider Name | Janet L Quarshie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083029466 PECOS PAC ID: 2062734957 Enrollment ID: I20141203002347 |
| Provider Name | Cheryl L Romana |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1053537522 PECOS PAC ID: 0648594143 Enrollment ID: I20150109001044 |
| Provider Name | Long Thao |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1457765349 PECOS PAC ID: 9537483706 Enrollment ID: I20150116000147 |
| Provider Name | Carrie Kneisl |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326305855 PECOS PAC ID: 8820252885 Enrollment ID: I20150128002090 |
| Provider Name | Nardin Ashkan |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1134353519 PECOS PAC ID: 7416271036 Enrollment ID: I20150130000197 |
| Provider Name | Thakshila Pathagamage |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1659599900 PECOS PAC ID: 8729303193 Enrollment ID: I20150205001020 |
| Provider Name | Heidi Jo Titze |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902201155 PECOS PAC ID: 7214252048 Enrollment ID: I20150218002462 |
| Provider Name | Inemienyu N Evbakhare |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225307135 PECOS PAC ID: 6901063312 Enrollment ID: I20150515000443 |
| Provider Name | Rachel L Rangoonwala |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447673405 PECOS PAC ID: 5991928152 Enrollment ID: I20151210002633 |
| Provider Name | Kelsie Anne Watson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376097329 PECOS PAC ID: 8022393990 Enrollment ID: I20170316001843 |
| Provider Name | Silvia Haydee Bernstrom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972893717 PECOS PAC ID: 5799114013 Enrollment ID: I20200407001505 |
| Provider Name | Shafi Abdulle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619525987 PECOS PAC ID: 1557792009 Enrollment ID: I20200515002420 |
| Provider Name | D Pierre Gingerich-boberg |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295186328 PECOS PAC ID: 8426343856 Enrollment ID: I20200529000245 |
| Provider Name | Elaine Catherine Gupta |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790376390 PECOS PAC ID: 2062828536 Enrollment ID: I20210308001663 |
| Provider Name | Kate Richards May |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720572845 PECOS PAC ID: 5395087779 Enrollment ID: I20210625000863 |
| Provider Name | Stacie Bistodeau |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740899756 PECOS PAC ID: 5597137711 Enrollment ID: I20230215002219 |
| Provider Name | Catherine Ann Watson Lund |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013504505 PECOS PAC ID: 6305210642 Enrollment ID: I20230328001152 |
| Provider Name | Alma Claudina Rosignoli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952065286 PECOS PAC ID: 9830564897 Enrollment ID: I20230405002665 |
| Provider Name | Tedbabework M Ayele |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700593811 PECOS PAC ID: 5698144327 Enrollment ID: I20230713001764 |
| Provider Name | Molly Meierding |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1548824915 PECOS PAC ID: 6406262179 Enrollment ID: I20240110002689 |
| Provider Name | Taylor Marie Miller |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1831791979 PECOS PAC ID: 8628440971 Enrollment ID: I20240222001794 |
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 | |
Healthpartners Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8170 33rd Ave S, Ms 21110q, Minneapolis, MN 55425 Phone: 952-883-7469 Fax: 952-883-5395 | |
Boynton Health Service Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 410 Church St Se, Minneapolis, MN 55455 Phone: 612-625-8400 Fax: 612-625-1434 | |
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 | |
M Health Fairview Masonic Institute For The Developing Brain Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2025 E River Pkwy, Minneapolis, MN 55414 Phone: 612-301-0115 | |
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 | |
Allina Health Home Hospital Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2925 Chicago Ave, Minneapolis, MN 55407 Phone: 612-262-7800 |