NPIMap

Organization Active NPI

Open Door Health Center

  • Federally Qualified Health Center (FQHC)
  • Shakopee, MN
National Provider Identifier
1114446283
Registry record updated Apr 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
OPEN DOOR HEALTH CENTER
Practice address
1617 Weston CT Ste 200
Shakopee, MN 55379-4717
Phone
(952) 492-6342
Fax
(652) 492-2631
NPI assigned
Sep 11, 2017
Last updated
Apr 8, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2026

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

Authorized official

Name
Jennifer Beckius
Title
Cfo
Phone
(507) 344-5507

Specialties & licenses 1

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

Addresses

Primary practice location

1617 Weston CT Ste 200
Shakopee, MN 55379-4717

Mailing address

309 Holly LN
Mankato, MN 56001-5422
Phone (507) 388-2120

Other practice location 1

115 Broadway St S
Jordan, MN 55352-1664
Phone (507) 388-2120

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150930001410 MN Part B Supplier - Clinic/Group Practice 7012944085 Receives reassigned benefits from 23 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mankato, MN; Shakopee, MN

Other NPIs on the same Medicare enrollment 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D2340604Open Door Health Center - Shakopee1617 Weston Court, Suite 200, Shakopee, MN 55379Certificate of waiverMar 18, 2028

National Provider Directory

National Provider Directory
Tax ID family
Open Door Health Center7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

309 Holly Ln
Mankato, MN 56001
Phone (507) 388-2120

1617 Weston Ct
Ste 200
Shakopee, MN 55379
Phone (952) 492-6342

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1505088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775606400000",
    "number": "1114446283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 HOLLY LN",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560015422",
            "telephone_number": "507-388-2120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1617 WESTON CT STE 200",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553794717",
            "telephone_number": "952-492-6342",
            "fax_number": "652-492-2631"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "115 Broadway St S",
            "address_purpose": "LOCATION",
            "city": "Jordan",
            "state": "MN",
            "postal_code": "553521664",
            "country_code": "US",
            "telephone_number": "507-388-2120",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OPEN DOOR HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-11",
        "last_updated": "2026-04-08",
        "certification_date": "2026-04-08",
        "status": "A",
        "authorized_official_last_name": "BECKIUS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "507-344-5507"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shakopee, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.