Serge B Pierrecharles Medical Group PLLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

58656 Issued in MN

Legal business name

SERGE B PIERRECHARLES MEDICAL GROUP PLLC

Practice address

9220 Bass Lake Rd
Suite 350
New Hope, MN 55428-3095

Phone

(763) 208-9545

Fax

(651) 927-8668

NPI assigned

Oct 4, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Serge B Pierrecharles, MDNPI 1609167980

Title

Owner

Phone

(646) 234-3795

Specialties & licenses 1

Addresses

Other names 2

• Elixir Sports Medicine, Pain, Spine, Rehabilitation & Wellness Center Doing business as
• Superior Performance Center sports Medicine, Pain, Spine, Rehabilitat Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 2

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

• Serge Pierrecharles, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Lakeway, TX
  • NPI 1609167980

  MN

  Medicare reassignment NPD Authorized official
• Lee Eugene Chisholm

  • Physical Therapist
  • Dublin, CA
  • NPI 1306314117

  MN

  Medicare reassignment NPD

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

{
    "created_epoch": "1507075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585094400000",
    "number": "1083124010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9220 BASS LAKE RD",
            "address_2": "SUITE 350",
            "city": "NEW HOPE",
            "state": "MN",
            "postal_code": "554283095",
            "telephone_number": "763-208-9545",
            "fax_number": "651-927-8668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9220 BASS LAKE RD",
            "address_2": "SUITE 350",
            "city": "NEW HOPE",
            "state": "MN",
            "postal_code": "554283095",
            "telephone_number": "763-208-9545",
            "fax_number": "651-927-8668"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "360 Sherman St Ste 300",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551022566",
            "country_code": "US",
            "telephone_number": "763-208-9545",
            "fax_number": "651-927-8668",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SERGE B PIERRECHARLES MEDICAL GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-04",
        "last_updated": "2020-03-25",
        "certification_date": "2020-03-25",
        "status": "A",
        "authorized_official_last_name": "PIERRECHARLES",
        "authorized_official_first_name": "SERGE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "646-234-3795",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MN",
            "license": "58656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elixir Sports Medicine, Pain, Spine, Rehabilitation & Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Superior Performance Center sports Medicine, Pain, Spine, Rehabilitat",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary Kay Schoen, LICSW
• Meagan Sue Schroeder, PHARM.D., RPH
• Chelsea Edith Schrunk Crivello
• Cora Eleanor Schultz, PTA
• Jennifer Ann Schwalbach, MA OTR/L
• Nikole Marie Sharpe, LICSW
• Susan Ella Shaw, LCSW, ASCW
• Kathran Shea
• Ilyssa Siegel, PSYD
• Rachel Siegel, SLP

• Clinic/Center in New Hope, MN
• Providers in New Hope, MN by specialty
• Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.