NPIMap

Organization Active NPI

Shakopee Mdewakanton Sioux Community

  • Family Medicine Physician
  • Prior Lake, MN
National Provider Identifier
1013933381
Registry record updated Jan 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
Practice address
2330 Sioux TRL NW
Prior Lake, MN 55372-9077
Phone
(952) 496-6150
Fax
(952) 233-4224
NPI assigned
Jul 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2025

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

Authorized official

Name
Ms. Melaine J Dunlap, CFNP
Title
Health Director
Phone
(952) 496-6151

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Occupational Therapy AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 224Z00000X
Physical Therapy AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 225200000X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

2330 Sioux TRL NW
Prior Lake, MN 55372-9077

Mailing address

2330 Sioux TRL NW
Prior Lake, MN 55372-9077
Phone (952) 496-6150

Other practice location 1

15000 Mystic Center Drive
Prior Lake, MN 55372
Phone (952) 233-2886

Other practice location 2

2360 Sioux Trl NW
Prior Lake, MN 55372-9077
Phone (952) 233-2886

Other practice location 3

2705 Wozani Ocanku NW
Prior Lake, MN 55372
Phone (952) 233-2886

Other names 1

  • Shakopee Dakota Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250626003507 MN Part B Supplier - Clinic/Group Practice 6901861087 Receives reassigned benefits from 20 practitioners
Practice locations: Prior Lake, MN

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
24D0864231Shakopee Dakota Clinic2330 Sioux TR NW, Prior Lake, MN 55372ComplianceSep 27, 2027

National Provider Directory

National Provider Directory

Locations

2330 Sioux Trl NW
Prior Lake, MN 55372
Phone (952) 496-6148

2525 Flandreau Trl
Prior Lake, MN 55372
Phone (952) 233-1077

2360 Sioux Trl NW
Prior Lake, MN 55372
Phone (952) 233-2886

Practitioners & affiliated clinicians

Practitioners 30

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

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738281600000",
    "number": "1013933381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2330 SIOUX TRL NW",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553729077",
            "telephone_number": "952-496-6150",
            "fax_number": "952-233-4224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2330 SIOUX TRL NW",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553729077",
            "telephone_number": "952-496-6150",
            "fax_number": "952-233-4224"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15000 Mystic Center Drive",
            "address_purpose": "LOCATION",
            "city": "Prior Lake",
            "state": "MN",
            "postal_code": "55372",
            "country_code": "US",
            "telephone_number": "952-233-2886",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2360 Sioux Trl NW",
            "address_purpose": "LOCATION",
            "city": "Prior Lake",
            "state": "MN",
            "postal_code": "553729077",
            "country_code": "US",
            "telephone_number": "952-233-2886",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2705 Wozani Ocanku NW",
            "address_purpose": "LOCATION",
            "city": "Prior Lake",
            "state": "MN",
            "postal_code": "55372",
            "country_code": "US",
            "telephone_number": "952-233-2886",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SHAKOPEE MDEWAKANTON SIOUX COMMUNITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2025-01-31",
        "certification_date": "2025-01-31",
        "status": "A",
        "authorized_official_last_name": "DUNLAP",
        "authorized_official_first_name": "MELAINE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "HEALTH DIRECTOR",
        "authorized_official_telephone_number": "952-496-6151",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CFNP"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shakopee Dakota Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prior Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.