NPIMap

Organization Active NPI

Medical Care Services, PA

  • Family Medicine Physician
  • New Brighton, MN
National Provider Identifier
1083778708
Registry record updated Dec 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1490 Issued in MN
Legal business name
MEDICAL CARE SERVICES, PA
Practice address
900 Long Lake Rd
Ste 106
New Brighton, MN 55112-6414
Phone
(612) 706-9630
Fax
(612) 706-9617
NPI assigned
Dec 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2021

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

Authorized official

Name
Dr. Spencer Allan Johnson, MDNPI 1881692549
Title
VP
Phone
(612) 706-9630

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 1490 MN Primary

Addresses

Primary practice location

900 Long Lake Rd
Ste 106
New Brighton, MN 55112-6414

Mailing address

900 Long Lake Rd
Ste 106
New Brighton, MN 55112-6414
Phone (612) 706-9630

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091216000591 MN Part B Supplier - Clinic/Group Practice 5890865463 Receives reassigned benefits from 26 practitioners
Practice locations: Edina, MN; New Brighton, MN

National Provider Directory

National Provider Directory

Locations

4001 Stinson Blvd NE
Ste 404
Minneapolis, MN 55421
Phone (612) 706-9630

900 Long Lake Rd
Ste 106
New Brighton, MN 55112
Phone (612) 706-9630

900 Long Lake Rd
Ste 160
Saint Paul, MN 55112
Phone (612) 706-9630

Practitioners & affiliated clinicians

Practitioners 43

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

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639440000000",
    "number": "1083778708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 LONG LAKE RD",
            "address_2": "STE 106",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551126414",
            "telephone_number": "612-706-9630",
            "fax_number": "612-706-9617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 LONG LAKE RD",
            "address_2": "STE 106",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551126414",
            "telephone_number": "612-706-9630",
            "fax_number": "612-706-9617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL CARE SERVICES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-20",
        "last_updated": "2021-12-14",
        "certification_date": "2021-12-14",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "SPENCER",
        "authorized_official_middle_name": "ALLAN",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "612-706-9630",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "1490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Brighton, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2021; 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.