Neighborhood Healthsource

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

NEIGHBORHOOD HEALTHSOURCE

Practice address

342 13TH Ave NE
Minneapolis, MN 55413-1265

Phone

(612) 588-9411

Fax

(612) 362-4115

NPI assigned

Jun 3, 2006

Last updated

Jun 29, 2023By 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

Mr. Steve J Knutson

Title

Executive Director

Phone

(612) 287-2428

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Fremont Community Health Services, Inc Former legal business name

Medicare fee-for-service enrollment

Enrolled in MN2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093753782. Details of each certification follow.

• CCN 241822 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 241822

Legal name

NEIGHBORHOOD HEALTHSOURCE

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Mar 20, 1996

Last certification

Mar 20, 1996

Ownership / control type

For profit – partnership

Organization structure

CorporationNon-profit

Incorporated

Jun 18, 1975 in MN

Enrollment address

342 13TH Ave NE
Minneapolis, MN 55413-1265

Other NPIs with the same Medicare PAC ID 3

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

• Neighborhood Healthsource

  • Federally Qualified Health Center (FQHC)
  • Minneapolis, MN
  • NPI 1386682078

  9133199953

  Same PAC ID
• Neighborhood Healthsource

  dba North Metro Clinic

  • Federally Qualified Health Center (FQHC)
  • Coon Rapids, MN
  • NPI 1659323459

  9133199953

  Same PAC ID
• Neighborhood Healthsource

  dba Central Clinic

  • Federally Qualified Health Center (FQHC)
  • Minneapolis, MN
  • NPI 1811934763

  9133199953

  Same PAC ID

Other NPIs on the same Medicare enrollment 3

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

• Neighborhood Healthsource

  • Federally Qualified Health Center (FQHC)
  • Minneapolis, MN
  • NPI 1386682078

  O20040729000231

  Same enrollment
• Neighborhood Healthsource

  dba North Metro Clinic

  • Federally Qualified Health Center (FQHC)
  • Coon Rapids, MN
  • NPI 1659323459

  O20040729000231

  Same enrollment
• Neighborhood Healthsource

  dba Central Clinic

  • Federally Qualified Health Center (FQHC)
  • Minneapolis, MN
  • NPI 1811934763

  O20040729000231

  Same enrollment

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 disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Roberta Ridyn Kelley, LMFT

  • Marriage & Family Therapist
  • Plymouth, MN
  • NPI 1538831987

  Corporate Director

  CMS ownership

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687996800000",
    "number": "1093753782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "342 13TH AVE NE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554131265",
            "telephone_number": "612-588-9411",
            "fax_number": "612-362-4115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "342 13TH AVE NE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554131265",
            "telephone_number": "612-588-9411",
            "fax_number": "612-362-4115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEIGHBORHOOD HEALTHSOURCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A",
        "authorized_official_last_name": "KNUTSON",
        "authorized_official_first_name": "STEVE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "612-287-2428",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "591315200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fremont Community Health Services, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Fremont Community Health Services, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Amirmasoud Negarestani, M.D
• Roseanne Negash, OTR/L
• Tiruayer Negatu
• Joseph P Neglia, M.D., M.P.H.
• Nikolaus William Neiberger
• Neighborhood Healthsource
• Neighborhood Healthsource (Central Clinic)
• Neighborhood Involvement Program
• Daniel Neighbors, DPT
• Brian Joseph Neil, MD

• Federally Qualified Health Center (FQHC) in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Federally Qualified Health Center (FQHC) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2023; 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.