Integro Clinic PLLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

INTEGRO CLINIC PLLC

Practice address

6545 France Ave S Ste 501
Edina, MN 55435-2116

Phone

(612) 428-4757

NPI assigned

Jun 16, 2023

Last updated

May 23, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Alfredo A Massa Succar, MDNPI 1639362361

Title

MD/Owner

Phone

(612) 695-0949

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 3

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.

• Alfredo A Massa Succar, M.D.

  • Psychiatry Physician
  • Fridley, MN
  • NPI 1639362361
  Medicare reassignment NPD Authorized official
• Alina Amunrud

  • Psychiatric/Mental Health Nurse Practitioner
  • Fridley, MN
  • NPI 1407529332
  Medicare reassignment NPD
• Nicole Peluso, CNP

  • Nurse Practitioner
  • Edina, MN
  • NPI 1144881962
  Medicare reassignment NPD

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

{
    "created_epoch": "1686873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716422400000",
    "number": "1114602281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6013 KILLARNEY LN S",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554361811",
            "telephone_number": "614-817-8141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6545 FRANCE AVE S STE 501",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352116",
            "telephone_number": "612-428-4757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRO CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-16",
        "last_updated": "2024-05-23",
        "certification_date": "2024-05-23",
        "status": "A",
        "authorized_official_last_name": "MASSA SUCCAR",
        "authorized_official_first_name": "ALFREDO",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "612-695-0949",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Institute for Therapy & Behavior Change, LTD.
• Integra Dermatology PA
• Integrated Health of Minnesota LLC
• Integrated Provider Group of Minnesota
• Integrative Immunity Health System PC
• Interlachen Dental Associates
• Interlachen Dental Associates
• Interlachen Lodge Operated by Interlodge
• Intermed Consultants Dialysis, PLLC
• Intermed Consultants,LTD.

• Psychiatry Physician in Edina, MN
• Providers in Edina, MN by specialty
• Psychiatry Physician in Minnesota

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