Organization Active NPI

Good Clinic MN PLLC

  • Primary Care Clinic/Center
  • St Louis Park, MN
National Provider Identifier
1003423252
Registry record updated Jan 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
GOOD CLINIC MN PLLC
Practice address
4712 Excelsior Blvd
St Louis Park, MN 55416-3008
Phone
(844) 383-8689
NPI assigned
Sep 30, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kevin Lee Smith, DNP
Title
Chief Nurse Practitioner Officer
Phone
(763) 639-5327

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

4712 Excelsior Blvd
St Louis Park, MN 55416-3008

Mailing address

1660 Highway 100 S Ste 432
St Louis Park, MN 55416-1533

Other practice location 1

845 Vikings Pkwy Ste B
Eagan, MN 55121-1002
Phone (651) 650-0500

Other practice location 2

7881 Main St N Ste 538
Maple Grove, MN 55369-7082
Phone (651) 650-0400

Other practice location 3

246 Snelling Ave S Ste 1
Saint Paul, MN 55105-2019
Phone (651) 650-0300

Other practice location 4

307 1St Ave NE
Minneapolis, MN 55413-5001
Phone (763) 639-5327

Other practice location 5

12900 Technology Dr Ste 140
Eden Prairie, MN 55344-2638
Phone (844) 383-8689 ext. 704

Other names 1

  • The Good Clinic Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D2230068Good Clinic MN PLLC12900 Technology Dr, Eden Prairie, MN 55344Certificate of waiverJul 19, 2027

National Provider Directory

National Provider Directory

Locations

12900 Technology Dr
Ste 140
Eden Prairie, MN 55344
Phone 8443838689 ext. 704

7881 Main St N
Maple Grove, MN 55369

7811 Main St N
Maple Grove, MN 55369

7881 Main St N
Ste 538
Maple Grove, MN 55369
Phone (651) 650-0400

315 1st Ave NE
Minneapolis, MN 55413

4190 Vinewood Ln N
Ste 111567
Plymouth, MN 55442

845 Vikings Pkwy
Saint Paul, MN 55121

845 Vikings Pkwy
#B
Saint Paul, MN 55121

1660 Highway 100 S
Ste 432
St Louis Park, MN 55416

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1601424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642118400000",
    "number": "1003423252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1660 HIGHWAY 100 S STE 432",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554161533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4712 EXCELSIOR BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554163008",
            "telephone_number": "844-383-8689"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "845 Vikings Pkwy Ste B",
            "address_purpose": "LOCATION",
            "city": "Eagan",
            "state": "MN",
            "postal_code": "551211002",
            "country_code": "US",
            "telephone_number": "651-650-0500",
            "fax_number": "651-650-0501",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7881 Main St N Ste 538",
            "address_purpose": "LOCATION",
            "city": "Maple Grove",
            "state": "MN",
            "postal_code": "553697082",
            "country_code": "US",
            "telephone_number": "651-650-0400",
            "fax_number": "651-650-0401",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "246 Snelling Ave S Ste 1",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551052019",
            "country_code": "US",
            "telephone_number": "651-650-0300",
            "fax_number": "651-650-0301",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "307 1ST AVE NE",
            "address_purpose": "LOCATION",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554135001",
            "country_code": "US",
            "telephone_number": "763-639-5327",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12900 Technology Dr Ste 140",
            "address_purpose": "LOCATION",
            "city": "Eden Prairie",
            "state": "MN",
            "postal_code": "553442638",
            "country_code": "US",
            "telephone_number": "844-383-8689 x704",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GOOD CLINIC MN PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-30",
        "last_updated": "2022-01-14",
        "certification_date": "2022-01-11",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CHIEF NURSE PRACTITIONER OFFICER",
        "authorized_official_telephone_number": "763-639-5327",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Good Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Good Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Louis Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.