Allina Health System

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

ALLINA HEALTH SYSTEM

Doing business as

Allina Health Bandana Square Clinic

Practice address

1021 Bandana Blvd E
Ste 100
St Paul, MN 55108-5109

Phone

(651) 241-9700

NPI assigned

Jan 27, 2011

Last updated

Jan 14, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dominica Tallarico

Title

Coo

Phone

(612) 222-2222

Specialties & licenses 4

Addresses

Other names 1

• Allina Health Bandana Square Clinic Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MN3 enrollments

Enrollment records 3

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

CLIA laboratory certificates

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Practitioners 49

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Megan Catherine Anderson, DO

  • Emergency Medicine Physician
  • Minneapolis, MN
  • NPI 1780213231
  NPD
• Michael Burgdorf

  • Family Medicine Physician
  • Northfield, MN
  • NPI 1003497306
  NPD
• Marcus Burns

  • Adult Health Nurse Practitioner
  • Minneapolis, MN
  • NPI 1750767737
  NPD
• Jessica J Dehler, PA-C

  • Physician Assistant
  • Minneapolis, MN
  • NPI 1245354018
  NPD
• Abdulrazak Esse, MD

  • Internal Medicine Physician
  • Minneapolis, MN
  • NPI 1407143803
  NPD
• Abby Foley

  • Clinical Social Worker
  • Minneapolis, MN
  • NPI 1326642653
  NPD
• Elizabeth Anne Frankman, MD

  • Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
  • Saint Paul, MN
  • NPI 1821297987
  NPD
• Mara Joan Fritz, NP

  • Acute Care Nurse Practitioner
  • Minneapolis, MN
  • NPI 1952950065
  NPD
• Adam J Goble, ARNP

  • Nurse Practitioner
  • Rochester, MN
  • NPI 1205195385
  NPD
• Michele D Granada, MD

  • Infectious Disease Physician
  • Minneapolis, MN
  • NPI 1487971941
  NPD
• Hasti Hadizadeh Davaji, MD

  • Psychiatry Physician
  • Cambridge, MN
  • NPI 1811563752
  NPD
• Ellen Hanson, CNP

  • Nurse Practitioner
  • Champlin, MN
  • NPI 1073318598
  NPD

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

{
    "created_epoch": "1296086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736812800000",
    "number": "1023314804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 43",
            "address_2": "MAIL ROUTE 10585",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554400043",
            "telephone_number": "612-262-1166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 BANDANA BLVD E",
            "address_2": "STE 100",
            "city": "ST PAUL",
            "state": "MN",
            "postal_code": "551085109",
            "telephone_number": "651-241-9700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1010 Bandana Blvd E",
            "address_2": "STE 236",
            "address_purpose": "LOCATION",
            "city": "St Paul",
            "state": "MN",
            "postal_code": "551085107",
            "country_code": "US",
            "telephone_number": "651-641-7100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ALLINA HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-27",
        "last_updated": "2025-01-14",
        "certification_date": "2025-01-14",
        "status": "A",
        "authorized_official_last_name": "TALLARICO",
        "authorized_official_first_name": "DOMINICA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "612-222-2222"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207QS1201X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QS1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Sleep Disorder Diagnostic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "esmd.cioxhealth.com and OID is '2.16.840.1.113883.3.6635.1.1",
            "affiliationName": "Ciox Health",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "925 N Point Pkwy",
            "city": "Alpharetta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300055210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Allina Health Bandana Square Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Allina Health Bandana Square Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Allied Homes Limited Liability Company
• Allied Operation Support LLC
• Allied Physical Therapy LLC
• Allied Support LLC
• Allina Health System (Allina Health United General Surgery Clinic)
• Allina Health System (United Hospital Inpatient Pharmacy)
• Allina Health System (Allina Health United Medical Specialties Clinic)
• Allina Health System (United Hospital)
• Allina Health System (Allina Health Brain and Spine Institute - St Paul Neuropsychology)
• Allina Health System (Allina Health Brain and Spine Institute - St Paul)

• Family Medicine Physician in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.