NPIMap

Organization Active NPI

Community Medical Services Montana Private LLC

Doing business as Community Medical Services-Minneapolis on Broadway

  • Methadone Clinic
  • Minneapolis, MN
National Provider Identifier
1033804653
Registry record updated Jul 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
Legal business name
COMMUNITY MEDICAL SERVICES MONTANA PRIVATE LLC
Doing business as
Community Medical Services-Minneapolis on Broadway
Practice address
1020 West Broadway
Minneapolis, MN 55411-2504
Phone
(612) 895-3850
Fax
(612) 945-4710
NPI assigned
Apr 10, 2023
Last updated
Jul 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2024

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

Authorized official

Name
Cindy Gaither
Title
VP of Revenue Cycle Management
Phone
(602) 248-8886

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Community/Behavioral Health Agency 251S00000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Methadone Clinic 261QM2800X Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X

Addresses

Primary practice location

1020 West Broadway
Minneapolis, MN 55411-2504

Mailing address

8444 N 90TH St Ste 100
Scottsdale, AZ 85258-4437
Phone (602) 248-8886

Other names 1

  • Community Medical Services-Minneapolis on Broadway Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Opioid treatment program
Medicare-enrolled since Jun 25, 2024

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240910000517 MN Part B Supplier - Opioid Treatment Program (Otp) 8729414362 1 other NPI on this enrollment
Practice locations: Roseville, MN; Minneapolis, MN

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
24D2267954Community Medical Services -1020 West Broadway, Minneapolis, MN 55411Certificate of waiverSep 1, 2026

National Provider Directory

National Provider Directory
Tax ID family
Community Medical Services Montana-Private LLC34 organizations share this tax ID, including this one

Other organizations with this tax ID 33

Organizations that report the same tax identification number in the National Provider Directory.

View all 33

Locations

2350 Cleveland Ave N
Roseville, MN 55113
Phone (507) 850-1100

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1681084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721779200000",
    "number": "1033804653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8444 N 90TH ST STE 100",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852584437",
            "telephone_number": "602-248-8886",
            "fax_number": "480-687-7361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 WEST BROADWAY",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554112504",
            "telephone_number": "612-895-3850",
            "fax_number": "612-945-4710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEDICAL SERVICES MONTANA PRIVATE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-10",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A",
        "authorized_official_last_name": "GAITHER",
        "authorized_official_first_name": "CINDY",
        "authorized_official_title_or_position": "VP OF REVENUE CYCLE MANAGEMENT",
        "authorized_official_telephone_number": "602-248-8886"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Medical Services-Minneapolis on Broadway",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Community Medical Services-Minneapolis on Broadway",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2024; 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.