NPIMap

Organization Active NPI

Stellis Health, PA

  • Multi-Specialty Clinic/Center
  • Albertville, MN
National Provider Identifier
1205022845
Registry record updated Aug 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
STELLIS HEALTH, PA
Practice address
11091 Jason Ave NE
Albertville, MN 55301
Phone
(763) 684-8300
NPI assigned
Sep 18, 2007
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
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 with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

11091 Jason Ave NE
Albertville, MN 55301

Mailing address

11091 Jason Ave NE
Albertville, MN 55301
Phone (763) 684-8300

Other names 1

  • Stellis Health - Albertville-St. Michael Clinic Other name

Medicare participation

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

Enrollment records 1

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
This NPI is an additional NPI on the enrollment
Practice locations: Buffalo, MN; Monticello, 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

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

Practitioners & affiliated clinicians

Practitioners 12

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": "1190073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470960000000",
    "number": "1205022845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11091 JASON AVE NE",
            "city": "ALBERTVILLE",
            "state": "MN",
            "postal_code": "55301",
            "telephone_number": "763-684-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11091 JASON AVE NE",
            "city": "ALBERTVILLE",
            "state": "MN",
            "postal_code": "55301",
            "telephone_number": "763-684-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STELLIS HEALTH, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-18",
        "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_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stellis Health - Albertville-St. Michael Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Albertville, 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.