NPIMap

Organization Active NPI

Yourtime Psychiatry and Medical Cannabis LLC

  • Clinic/Center
  • Maple Grove, MN
National Provider Identifier
1164112090
Registry record updated May 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
YOURTIME PSYCHIATRY AND MEDICAL CANNABIS LLC
Practice address
6341 Ithaca LN N
Maple Grove, MN 55311-4147
Phone
(612) 458-3374
NPI assigned
May 12, 2023
Last updated
May 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2023

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

Authorized official

Name
John HarrisonNPI 1205418340
Title
Owner
Phone
(612) 458-3374

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

6341 Ithaca LN N
Maple Grove, MN 55311-4147

Mailing address

6341 Ithaca LN N
Maple Grove, MN 55311-4147

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230905003315 MN Part B Supplier - Clinic/Group Practice 4082077201 Receives reassigned benefits from 9 practitioners
Practice locations: Plymouth, MN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1683849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683849600000",
    "number": "1164112090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6341 ITHACA LN N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553114147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6341 ITHACA LN N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553114147",
            "telephone_number": "612-458-3374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOURTIME PSYCHIATRY AND MEDICAL CANNABIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-12",
        "last_updated": "2023-05-12",
        "certification_date": "2023-05-12",
        "status": "A",
        "authorized_official_last_name": "HARRISON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-458-3374"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Grove, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2023; 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.