NPIMap

Organization Active NPI

Family Healthservices Minnesota, P.a.

  • Family Medicine Physician
  • North St Paul, MN
National Provider Identifier
1083894711
Registry record updated Oct 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1428 Issued in MN
Legal business name
FAMILY HEALTHSERVICES MINNESOTA, P.A.
Practice address
2601 Centennial Dr Ste 100
North St Paul, MN 55109-3087
Phone
(651) 788-4444
Fax
(651) 748-5839
NPI assigned
Nov 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2025

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

Authorized official

Name
Ken Palattao
Title
Cao
Phone
(651) 772-1572

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 1428 MN Primary
Sports Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081S0010X

Addresses

Primary practice location

2601 Centennial Dr Ste 100
North St Paul, MN 55109-3087

Mailing address

2025 Sloan PL Ste 35
Saint Paul, MN 55117-2092
Phone (651) 772-1572

Other names 1

  • Entira Family Clinics-North St. Paul Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071215000036 MN Part B Supplier - Clinic/Group Practice 1355369018 Receives reassigned benefits from 60 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Saint Paul, MN; Woodbury, MN; West St Paul, MN; Vadnais Heights, MN; Shoreview, MN; Hugo, MN; North St Paul, MN

Other NPIs on the same Medicare enrollment 8

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
24D0667501Entira Family Clinics North St Paul2601 Centennial Dr Suite 100, North Saint Paul, MN 55109AccreditationDec 22, 2027

National Provider Directory

National Provider Directory

Locations

2601 Centennial Dr
Ste 100
Saint Paul, MN 55109
Phone (651) 777-7414

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1194566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760400000000",
    "number": "1083894711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2025 SLOAN PL STE 35",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551172092",
            "telephone_number": "651-772-1572",
            "fax_number": "651-772-1889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 CENTENNIAL DR STE 100",
            "city": "NORTH ST PAUL",
            "state": "MN",
            "postal_code": "551093087",
            "telephone_number": "651-788-4444",
            "fax_number": "651-748-5839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTHSERVICES MINNESOTA, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-09",
        "last_updated": "2025-10-14",
        "certification_date": "2025-10-14",
        "status": "A",
        "authorized_official_last_name": "PALATTAO",
        "authorized_official_first_name": "KEN",
        "authorized_official_title_or_position": "CAO",
        "authorized_official_telephone_number": "651-772-1572"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "1428",
            "primary": true
        },
        {
            "code": "2081S0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Entira Family Clinics-North St. Paul",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Entira Family Clinics-North St. Paul",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North St Paul, MN

Sources for this page

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