Bloomington Lake Clinic, LTD

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

23 Issued in MN

Legal business name

BLOOMINGTON LAKE CLINIC, LTD

Practice address

7901 Xerxes Ave S Ste 116
Bloomington, MN 55431-1200

Phone

(952) 888-2024

Fax

(952) 888-3985

NPI assigned

Dec 18, 2006

Organization subpart

No

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

Authorized official

Name

Debra J Barger

Title

Assistant Administrator

Phone

(612) 277-2165

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kirk W Simpson, MD

  • Family Medicine Physician
  • Mendota Heights, MN
  • NPI 1881759314
  NPD (past)

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301875200000",
    "number": "1215090501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7901 XERXES AVE S STE 116",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554311200",
            "telephone_number": "952-888-2024",
            "fax_number": "952-888-3985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7901 XERXES AVE S STE 116",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554311200",
            "telephone_number": "952-888-2024",
            "fax_number": "952-888-3985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMINGTON LAKE CLINIC, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2011-04-04",
        "status": "A",
        "authorized_official_last_name": "BARGER",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "ASSISTANT ADMINISTRATOR",
        "authorized_official_telephone_number": "612-277-2165"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "MN",
            "license": "23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "1713",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "302510100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE MINNESOTA",
            "identifier": "C406",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bloomington Drug Co
• Bloomington Drug Co.
• Bloomington Eye Center
• Bloomington Family Dental, PLLC
• Bloomington Home Care SC
• Bloomington Public Schools
• Bloomington Smiles Dentistry, PC
• Bloomington Wellness Center, PA
• Sydney Marie Bloomquist
• Blue Behavioral Therapy

• Multi-Specialty Clinic/Center in Bloomington, MN
• Providers in Bloomington, MN by specialty
• Multi-Specialty Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.