NPIMap

Organization Active NPI

Edina Sports Health & Wellness, PA

Doing business as Edina Sports and Family Medicine

  • Family Medicine Physician
  • Edina, MN
National Provider Identifier
1215010335
Registry record updated Jan 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
37465 Issued in MN
Legal business name
EDINA SPORTS HEALTH & WELLNESS, PA
Doing business as
Edina Sports and Family Medicine
Practice address
7701 York Ave S Ste 300
Edina, MN 55435-5864
Phone
(952) 926-6489
Fax
(952) 926-6501
NPI assigned
Oct 23, 2006
Last updated
Jan 24, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2022

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

Authorized official

Name
Rochelle R. Taube, MDNPI 1891995338
Title
Owner
Phone
(952) 926-6489

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
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 37465 MN Primary

Addresses

Primary practice location

7701 York Ave S Ste 300
Edina, MN 55435-5864

Mailing address

7701 York Ave S Ste 300
Edina, MN 55435-5864
Phone (952) 926-6489

Other identifiers 1

IdentifierTypeStateIssuer
550095800MedicaidMN

Other names 1

  • Edina Sports and Family Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040112000058 MN Part B Supplier - Clinic/Group Practice 7012817596 Receives reassigned benefits from 9 practitioners
Practice locations: Edina, MN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D1003175Edina Sports + Family Medicine7701 York Ave #300, Edina, MN 55435AccreditationSep 3, 2027

National Provider Directory

National Provider Directory

Locations

7701 York Ave S
Ste 300
Minneapolis, MN 55435
Phone (952) 915-5261

6363 France Ave S
Ste 525
Minneapolis, MN 55435
Phone (952) 230-9100

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642982400000",
    "number": "1215010335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7701 YORK AVE S STE 300",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554355864",
            "telephone_number": "952-926-6489",
            "fax_number": "952-926-6501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7701 YORK AVE S STE 300",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554355864",
            "telephone_number": "952-926-6489",
            "fax_number": "952-926-6501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDINA SPORTS HEALTH & WELLNESS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2022-01-24",
        "certification_date": "2022-01-24",
        "status": "A",
        "authorized_official_last_name": "TAUBE",
        "authorized_official_first_name": "ROCHELLE",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-926-6489",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "37465",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "550095800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edina Sports and Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edina, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.