NPIMap

Organization Active NPI

Active Feet, Foot & Ankle Health Center

Doing business as Midwest Podiatry Center St. Anthony

  • Foot & Ankle Surgery Podiatrist
  • Minneapolis, MN
National Provider Identifier
1164716387
Registry record updated Nov 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
ACTIVE FEET, FOOT & ANKLE HEALTH CENTER
Doing business as
Midwest Podiatry Center St. Anthony
Practice address
4001 Stinson Blvd Ste 120
Minneapolis, MN 55421-3424
Phone
(612) 788-8778
NPI assigned
Jun 6, 2011
Last updated
Nov 1, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2018

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

Authorized official

Name
Bryan Mohr, DPMNPI 1043215528
Title
Owner
Phone
(612) 788-8778

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
Foot & Ankle Surgery Podiatrist 213ES0103X NU Primary

Addresses

Primary practice location

4001 Stinson Blvd Ste 120
Minneapolis, MN 55421-3424

Mailing address

6625 Lyndale Ave S Ste 300
Minneapolis, MN 55423-2491
Phone (612) 788-8778

Other names 1

  • Midwest Podiatry Center St. Anthony Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080602000720 MN Part B Supplier - Clinic/Group Practice 1254401300 Receives reassigned benefits from 23 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Burnsville, MN; Cloquet, MN; Duluth, MN; Edina, MN; Hibbing, MN; Maple Grove, MN; Minneapolis, MN; Minnetonka, MN…

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

Locations

7430 80th St S
Ste 104
Cottage Grove, MN 55016
Phone (651) 459-9171

7501 80th St S
Ste 104
Cottage Grove, MN 55016
Phone (651) 459-9171

1804 Maple Grove Rd
Duluth, MN 55811
Phone (612) 200-8415

6545 France Ave S
Ste 571
Edina, MN 55435
Phone (952) 926-7696

134 Main St S
Hutchinson, MN 55350
Phone (612) 200-8028

9325 Upland Ln N
Ste 255
Maple Grove, MN 55369
Phone (763) 465-4263

825 Nicollet Mall
Ste 517
Minneapolis, MN 55402
Phone (612) 332-7720

6600 Lyndale Ave S
Ste 130
Richfield, MN 55423
Phone (612) 243-8999

3485 Willow Lake Blvd
Ste 300
Vadnais Heights, MN 55110
Phone (651) 765-8200

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1307318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541030400000",
    "number": "1164716387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6625 LYNDALE AVE S STE 300",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554232491",
            "telephone_number": "612-788-8778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 STINSON BLVD STE 120",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554213424",
            "telephone_number": "612-788-8778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE FEET, FOOT & ANKLE HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-06",
        "last_updated": "2018-11-01",
        "status": "A",
        "authorized_official_last_name": "MOHR",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-788-8778",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midwest Podiatry Center St. Anthony",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Midwest Podiatry Center St. Anthony",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2018; 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.