NPIMap

Organization Active NPI

Stellis Health, PA

Doing business as Buffalo Clinic, Monticello Clinic, Albertville/St.Michael Clinic,

  • Multi-Specialty Clinic/Center
  • Buffalo, MN
National Provider Identifier
1184664674
Registry record updated Aug 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
License
520 Issued in MN
Legal business name
STELLIS HEALTH, PA
Doing business as
Buffalo Clinic, Monticello Clinic, Albertville/St.Michael Clinic,
Practice address
1700 Highway 25 N
Buffalo, MN 55313-1930
Phone
(763) 682-1313
Fax
(763) 684-3790
NPI assigned
Jun 7, 2006
Last updated
Aug 12, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2016

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

Authorized official

Name
Dr. Jason S Halvorson, MDNPI 1033139159
Title
President
Phone
(763) 295-2921

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
Multi-Specialty Clinic/Center 261QM1300X 520 MN Primary

Addresses

Primary practice location

1700 Highway 25 N
Buffalo, MN 55313-1930

Mailing address

1700 Highway 25 N
Buffalo, MN 55313-1930
Phone (763) 682-1313

Other identifiers 1

IdentifierTypeStateIssuer
222310400MedicaidMN

Other names 1

  • Buffalo Clinic, Monticello Clinic, Albertville/St.Michael Clinic, Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031103000458 MN Part B Supplier - Clinic/Group Practice 1153233796 Receives reassigned benefits from 62 practitioners
2 other NPIs on this enrollment
Practice locations: Buffalo, MN; Monticello, MN
O20100930064548 MN DME Supplier - Multi-Specialty - Physician 1153233796 Practice locations: Buffalo, 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

Practitioners & affiliated clinicians

Practitioners 62

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 62

NPI Registry JSON

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470960000000",
    "number": "1184664674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 HIGHWAY 25 N",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "553131930",
            "telephone_number": "763-682-1313",
            "fax_number": "763-684-3790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 HIGHWAY 25 N",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "553131930",
            "telephone_number": "763-682-1313",
            "fax_number": "763-684-3790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STELLIS HEALTH, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-07",
        "last_updated": "2016-08-12",
        "status": "A",
        "authorized_official_last_name": "HALVORSON",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "763-295-2921",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "MN",
            "license": "520",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "222310400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Buffalo Clinic, Monticello Clinic, Albertville/St.Michael Clinic,",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Buffalo, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2016; 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.