NPIMap

Organization Active NPI

Minnesota Head and Neck Pain Clinic, PA

  • Specialist
  • St Paul, MN
National Provider Identifier
1104850155
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
MINNESOTA HEAD AND NECK PAIN CLINIC, PA
Practice address
2550 University Ave W
Ste 189S
St Paul, MN 55114
Phone
(651) 332-7474
Fax
(651) 332-7475
NPI assigned
Jul 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2024

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

Authorized official

Name
Ms. Tia A Reichert
Title
Chro/Clinic Administrator
Phone
(763) 577-2484

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

2550 University Ave W
Ste 189S
St Paul, MN 55114

Mailing address

3475 Plymouth Blvd Ste 200
Plymouth, MN 55447-1539
Phone (763) 577-2484

Other identifiers 1

IdentifierTypeStateIssuer
11668MIOtherMNBLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040804000709 MN Part B Supplier - Clinic/Group Practice 2769453687 Receives reassigned benefits from 20 practitioners
Practice locations: Plymouth, MN; Woodbury, MN; Saint Paul, MN; Burnsville, MN
O20151203001270 MN DME Supplier - Oral Surgery - Dentist 2769453687 Practice locations: St Paul, MN

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Minnesota Head Neck Pain5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

675 E Nicollet Blvd
Ste 255
Burnsville, MN 55337
Phone (952) 892-6222

Practitioners & affiliated clinicians

Practitioners 31

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

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721174400000",
    "number": "1104850155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3475 PLYMOUTH BLVD STE 200",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554471539",
            "telephone_number": "763-577-2484",
            "fax_number": "763-577-1375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 UNIVERSITY AVE W",
            "address_2": "STE 189S",
            "city": "ST PAUL",
            "state": "MN",
            "postal_code": "55114",
            "telephone_number": "651-332-7474",
            "fax_number": "651-332-7475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA HEAD AND NECK PAIN CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A",
        "authorized_official_last_name": "REICHERT",
        "authorized_official_first_name": "TIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHRO/CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "763-577-2484",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "11668MI",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 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.