Allina Health System
Organization Active NPI Surgery Physician · St Paul, MN
NPI 1003205410 · NPPES record last updated Jan 14, 2025
Key facts
- NPI
- 1003205410
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Surgery Physician 208600000X
- Legal business name
- ALLINA HEALTH SYSTEM
- Practice address
- 280 Smith Ave N Ste 700
St Paul, MN 55102-2972 - Phone
- (651) 241-3535
- NPI assigned
- Jan 22, 2015
- Organization subpart
- No
Authorized official
- Name
- Dominica Tallarico
- Title
- Coo
- Phone
- (612) 222-2222
Other NPIs on the same Medicare enrollment 14
Practitioners 45
-
Suresh Ahanya, MD
-
John David Breen, M.D.
-
David T Chang, MD
-
Mark T Destache, MD
-
Maureen Rose Doran, RD, LD
-
Milkeesso Foge, M.D.
-
Thomas Andrew Gebhard, M.D.
-
Jodi Danielle Gerdes, M.D.
-
Egal Ismail Gorse, M.D.
-
Brita M Hansen, MD
-
Sarah Imdieke, CNP
-
Terrell Gayperail Johnson, LICSW
-
Couzue F Karbbar, APRN-FNP
-
Kristopher Daniel Krueger, MD, PHD
-
Jill Nicole Lyle, CNP
-
Videh Mahajan, MD
-
Mary S. McMillan, MD
-
Kristen Medhanie, RN, CNP
-
Kirana Narayana, MD
-
Neelima Nyayapati, M.D.
-
Jeannie Elizabeth Paris, RD, LD
-
Rebecca Ann Pelkola, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in WI, MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031218000417 | WI | Part B Supplier - Clinic/Group Practice | 4587573613 |
Receives reassigned benefits from 522 practitioners 18 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Baldwin, WI; River Falls, WI; Grantsburg, WI; Prescott, WI |
| O20040319000460 | MN | Part B Supplier - Clinic/Group Practice | 4587573613 |
Receives reassigned benefits from 4,246 practitioners This NPI is an additional NPI on the enrollment |
| O20221213001713 | MN | Part B Supplier - Clinic/Group Practice | 4587573613 |
Receives reassigned benefits from 3,000 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
Locations
2833 Chicago Ave
Minneapolis, MN 55407
Phone (612) 863-3333
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician |
208600000X | Yes |
Addresses
Primary practice location
280 Smith Ave N Ste 700
St Paul, MN 55102-2972
Mailing address
PO Box 43
Mail Route 10585
Minneapolis, MN 55440-0043
Phone (612) 262-1166
Other names
- Allina Health United General Surgery Clinic
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service | Other | Ciox Health |
Other providers in St Paul, MN
- David Paul Allie
- Allied Homes Limited Liability Company
- Allied Operation Support LLC
- Allied Physical Therapy LLC
- Allied Support LLC
- Allina Health System
- Allina Health System
- Allina Health System
- Allina Health System
- Allina Health System
All providers in St Paul, MN · Surgery Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 14, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.