NPIMap

Organization Active NPI

Regents of the University of Minnesota

Doing business as Community-University Health Care Center

  • Federally Qualified Health Center (FQHC)
  • Minneapolis, MN
National Provider Identifier
1114019858
Registry record updated May 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
855553200 Issued in MN
Legal business name
REGENTS OF THE UNIVERSITY OF MINNESOTA
Doing business as
Community-University Health Care Center
Practice address
2001 Bloomington Ave
Minneapolis, MN 55404-3074
Phone
(612) 301-3433
Fax
(612) 627-4205
NPI assigned
Sep 29, 2006
Last updated
May 9, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
REGENTS OF THE UNIVERSITY OF MINNESOTAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 9, 2017

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

Authorized official

Name
Ms. Colleen McDonald-Diouf, MPH
Title
Ceo
Phone
(612) 301-0698

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 855553200 MN Primary

Addresses

Primary practice location

2001 Bloomington Ave
Minneapolis, MN 55404-3074

Mailing address

2001 Bloomington Ave
Minneapolis, MN 55404-3074
Phone (612) 301-3433

Other identifiers 1

IdentifierTypeStateIssuer
855553200MedicaidMN

Other names 1

  • Community-University Health Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061024000231 MN Part A Provider - Federally Qualified Health Center (FQHC) 7416856059 Practice locations: Minneapolis, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114019858. Details of each certification follow.

Federally qualified health center certification: CCN 241820

Legal name
REGENTS OF THE UNIVERSITY OF MINNESOTA
Doing business as
COMMUNITY -UNIVERSITY HEALTH CARE CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 19, 1995
Last certification
May 19, 1995
Ownership / control type
For profit – partnership
Organization structure
GovernmentNon-profit
Enrollment address
2001 Bloomington Ave
Minneapolis, MN 55404-3089

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
Part of
Comm-Univ HLTH Care Psy

Locations

1300 S 2nd St
Minneapolis, MN 55454
Phone (612) 302-8200

2001 Bloomington Ave
Minneapolis, MN 55404
Phone (612) 301-3433

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Suzanne M Lehman Individual Corporate Director Oct 29, 2018
Nathaniel Beske Individual Corporate Director Jan 1, 2016
Marion L Gomez Individual Corporate DirectorBoard Member Jun 26, 2017
Mary P Foarde Individual Corporate DirectorBoard Member Jun 25, 2018
Jake Horak Individual Corporate Director Dec 7, 2020
Roli Dwivedi Individual Corporate OfficerChief Executive Officer Jul 1, 2022
W-2 Managing Employee Jul 1, 2022
Sheila H Bowie Individual Corporate DirectorBoard Member Jul 17, 2018
Junaid M Niazi Individual Corporate DirectorBoard Member Jun 25, 2018

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 271

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 271

NPI Registry JSON

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494288000000",
    "number": "1114019858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 BLOOMINGTON AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554043074",
            "telephone_number": "612-301-3433",
            "fax_number": "612-627-4205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 BLOOMINGTON AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554043074",
            "telephone_number": "612-301-3433",
            "fax_number": "612-627-4205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENTS OF THE UNIVERSITY OF MINNESOTA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "REGENTS OF THE UNIVERSITY OF MINNESOTA",
        "enumeration_date": "2006-09-29",
        "last_updated": "2017-05-09",
        "status": "A",
        "authorized_official_last_name": "MCDONALD-DIOUF",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "612-301-0698",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MPH"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MN",
            "license": "855553200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "855553200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community-University Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.