NPIMap

Organization Active NPI

Northway Academy, Inc.

  • Developmental Disabilities Clinic/Center
  • Saint Cloud, MN
National Provider Identifier
1104333715
Registry record updated Jan 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X
Legal business name
NORTHWAY ACADEMY, INC.
Practice address
108 Doctors Park
Saint Cloud, MN 56303-1207
Phone
(320) 259-6022
Fax
(952) 922-6885
NPI assigned
Jan 4, 2018
Last updated
Jan 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2024

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

Authorized official

Name
Mary Patricia Rodenberg-Roberts
Title
Vice Pres & Sr. Asst GC
Phone
(952) 836-2234

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Developmental Disabilities Clinic/Center 261QD1600X Primary

Addresses

Primary practice location

108 Doctors Park
Saint Cloud, MN 56303-1207

Mailing address

6600 France Ave S Ste 350
Edina, MN 55435-1810
Phone (952) 563-2207

Other names 1

  • REM Central Lakes, Inc. Northway Academy Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211110002796 MN Part B Supplier - Clinic/Group Practice 6507255684 Receives reassigned benefits from 2 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sartell, MN; Saint Cloud, MN; Elk River, MN; Bloomington, MN; Duluth, MN; Alexandria, MN; Baxter, MN

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Tax ID family
Northway Academy Inc20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

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

View all 19

Locations

7938 College Rd
Baxter, MN 56425
Phone (218) 270-2918

19437 Evans St NW
Elk River, MN 55330
Phone (763) 515-3532

108 Doctors Park
Saint Cloud, MN 56303
Phone (320) 774-3915

205 14th Ave E
Sartell, MN 56377
Phone (320) 774-3436

Practitioners & affiliated clinicians

Practitioners 752

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 752

NPI Registry JSON

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

{
    "created_epoch": "1515024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705968000000",
    "number": "1104333715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 FRANCE AVE S STE 350",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554351810",
            "telephone_number": "952-563-2207",
            "fax_number": "952-922-6885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 DOCTORS PARK",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031207",
            "telephone_number": "320-259-6022",
            "fax_number": "952-922-6885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWAY ACADEMY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-04",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A",
        "authorized_official_last_name": "RODENBERG-ROBERTS",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "PATRICIA",
        "authorized_official_title_or_position": "VICE PRES & SR. ASST GC",
        "authorized_official_telephone_number": "952-836-2234"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "REM Central Lakes, Inc. Northway Academy",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Saint Cloud, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2024; 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.