NPIMap

Organization Active NPI

Mayo Collaborative Services, Inc

  • Physiological Laboratory
  • Rochester, MN
National Provider Identifier
1104587765
Registry record updated Apr 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
Legal business name
MAYO COLLABORATIVE SERVICES, INC
Practice address
4001 41St St NW
Rochester, MN 55901-8901
Phone
(800) 447-6424
NPI assigned
Jan 6, 2022
Organization subpart
Yes
Parent organization
MAYO COLLABORATIVE SERVICES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 19, 2023

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

Authorized official

Name
Dennis Eugene Dahlen
Title
Cfo
Phone
(507) 266-4416

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physiological Laboratory 293D00000X Primary

Addresses

Primary practice location

4001 41St St NW
Rochester, MN 55901-8901

Mailing address

PO Box 4100
Rochester, MN 55903-4100

Other names 2

  • Mayo Clinic Cardiovascular Services Doing business as
  • Mayo Collaborative Services, LLC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220525001499 MN Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 7719987486 Practice locations: Rochester, MN

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Mayo Medical Laboratories2 organizations share this tax ID, including this one
Part of
Mayo Medical Laboratories

Other organizations with this tax ID 1

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

21 2nd St SW
Ste 30
Rochester, MN 55902
Phone (507) 422-0099

4001 41st St NW
Rochester, MN 55901
Phone (800) 447-6424

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1641427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681862400000",
    "number": "1104587765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4100",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559034100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 41ST ST NW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559018901",
            "telephone_number": "800-447-6424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAYO COLLABORATIVE SERVICES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MAYO COLLABORATIVE SERVICES, LLC",
        "enumeration_date": "2022-01-06",
        "last_updated": "2023-04-19",
        "certification_date": "2023-04-19",
        "status": "A",
        "authorized_official_last_name": "DAHLEN",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "507-266-4416"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mayo Clinic Cardiovascular Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mayo Collaborative Services, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Rochester, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2023; 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.