Maple Grove Center for Restorative Surgery LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

MAPLE GROVE CENTER FOR RESTORATIVE SURGERY LLC

Practice address

13601 80TH Circle North
Suite 100
Maple Grove, MN 55369

Phone

(763) 432-7655

Fax

(763) 432-7501

NPI assigned

Feb 18, 2014

Last updated

Dec 19, 2019By 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

Daniel HansonNPI 1881690493

Title

Medical Director

Phone

(651) 324-8693

Specialties & licenses 2

Addresses

Listed as

Center for Restorative Surgery at Maple GroveCCN 24C0001106

Medicare certification status

Terminated Voluntary: merger or closure, Jan 1, 2026From the Provider of Services file

Locations

Practitioners 1

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.

• Daniel W Hanson, MD

  • Orthopaedic Surgery of the Spine Physician
  • Roseville, MN
  • NPI 1881690493
  NPD (past) Authorized official

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

{
    "created_epoch": "1392681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576713600000",
    "number": "1144644717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13601 80TH CIRCLE NORTH",
            "address_2": "SUITE 100",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "55369",
            "telephone_number": "763-432-7655",
            "fax_number": "763-432-7501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13601 80TH CIRCLE NORTH",
            "address_2": "SUITE 100",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "55369",
            "telephone_number": "763-432-7655",
            "fax_number": "763-432-7501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE GROVE CENTER FOR RESTORATIVE SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-18",
        "last_updated": "2019-12-19",
        "certification_date": "2019-12-19",
        "status": "A",
        "authorized_official_last_name": "HANSON",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "651-324-8693"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MN",
            "license": "679516700023",
            "primary": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Manasseh Home Healthcare LLC
• Michelle Lynn Mandler
• Roger L Mann
• Dianne Marie Mansfield, PT
• Maple Grove Center for Restorative Surgery
• Maple Grove Counseling Center PA
• Maple Grove Dialysis LLC (Maple Grove Dialysis Unit)
• Maple Grove Eye Care, LLC
• Maple Grove Family Dental Clinic, PA
• Maple Grove Hospital Corporation

• Ambulatory Surgical Clinic/Center in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Ambulatory Surgical Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.