Mindshape Clinic PLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

MINDSHAPE CLINIC PLC

Practice address

2560 Lynwood Dr Ste 3
Troy, MI 48083-5681

Phone

(515) 650-3031

NPI assigned

Sep 29, 2023

Last updated

Dec 9, 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

Hassan KhanNPI 1033631858

Title

Medical Director

Phone

(515) 650-3031

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• MindShape Clinic Other name

Medicare fee-for-service enrollment

Enrolled in MI, IN, NC, TX, IL, FL6 enrollments

Enrollment records 6

Practitioners 4

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.

• Hassan Khan, DO

  • Internal Medicine Physician
  • Shelby Township, MI
  • NPI 1033631858

  IN, NC

  Medicare reassignment Care Compare group NPD Authorized official
• Hamza Saifuddin Tahir, DO

  • Hospitalist Physician
  • The Woodlands, TX
  • NPI 1053976423

  IL, Internal Medicine

  Medicare reassignment Care Compare group NPD
• Jessica Anne Almerico, ARNP

  • Adult Health Nurse Practitioner
  • Boone, NC
  • NPI 1407174949

  FL

  Medicare reassignment NPD
• Benjamin Cale Friesen

  • Family Nurse Practitioner
  • Plymouth, IN
  • NPI 1366905275
  NPD (past)

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

{
    "created_epoch": "1695945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733702400000",
    "number": "1174303077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2560 LYNWOOD DR",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480835681",
            "telephone_number": "515-650-3031",
            "fax_number": "515-219-4772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2560 LYNWOOD DR STE 3",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480835681",
            "telephone_number": "515-650-3031"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1863 Lilac Rd Ste 3",
            "address_purpose": "LOCATION",
            "city": "Plymouth",
            "state": "IN",
            "postal_code": "465639542",
            "country_code": "US",
            "telephone_number": "515-650-3031",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "448 N Parker Church Rd Ste 3",
            "address_purpose": "LOCATION",
            "city": "Raeford",
            "state": "NC",
            "postal_code": "283769420",
            "country_code": "US",
            "telephone_number": "515-650-3031",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MINDSHAPE CLINIC PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-29",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-09",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "HASSAN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "515-650-3031"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100785550",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00427241",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MindShape Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Samantha Mindell, MSN, RN, ACNPC-AG
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• Mindmingle LLC
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• Christopher Minnock, M.D.
• Mary Minoza, NP
• Nicole M Minty, LMSW

• Internal Medicine Physician in Troy, MI
• Providers in Troy, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 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.