NPIMap

Organization Active NPI

Northwestern Health Sciences University

  • Multi-Specialty Clinic/Center
  • Bloomington, MN
National Provider Identifier
1124103544
Registry record updated Dec 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
NORTHWESTERN HEALTH SCIENCES UNIVERSITY
Practice address
2501 W 84TH St
Bloomington, MN 55431-1602
Phone
(952) 888-4777
Fax
(952) 886-7590
NPI assigned
Oct 25, 2006
Last updated
Dec 27, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2021

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

Authorized official

Name
Dr. John B Wolfe Jr., D.C.,J.D.
Title
Compliance Officer
Phone
(952) 888-4777

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

2501 W 84TH St
Bloomington, MN 55431-1602

Mailing address

2501 West 84TH Street
Bloomington, MN 55431-1599
Phone (952) 888-4777

Other identifiers 1

IdentifierTypeStateIssuer
7261471MedicaidMN

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Bloomington

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040513000112 MN Part B Supplier - Clinic/Group Practice 8820088834 Receives reassigned benefits from 9 practitioners
Practice locations: Bloomington, MN

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
24D0718074Northwestern Health Sciences2501 W 84TH Street, Bloomington, MN 55431Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Radiological Cons Serv2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

12445 River Ridge Blvd
Burnsville, MN 55337
Phone (651) 894-7620

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 85

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 85

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640563200000",
    "number": "1124103544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2501 WEST 84TH STREET",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554311599",
            "telephone_number": "952-888-4777",
            "fax_number": "952-886-7590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 W 84TH ST",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554311602",
            "telephone_number": "952-888-4777",
            "fax_number": "952-886-7590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWESTERN HEALTH SCIENCES UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2021-12-27",
        "certification_date": "2021-12-27",
        "status": "A",
        "authorized_official_last_name": "WOLFE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "952-888-4777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "D.C.,J.D."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7261471",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Bloomington",
            "affiliation": "N",
            "address_1": "2501 W 84th St",
            "city": "Bloomington",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554311602",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bloomington, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2021; 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.