Northside Medical Center, PLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

NORTHSIDE MEDICAL CENTER, PLC

Practice address

465 Eastvold Ave
Ortonville, MN 56278-1107

Phone

(320) 839-6157

Fax

(320) 839-3851

NPI assigned

Mar 16, 2006

Last updated

Dec 8, 2008By 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

Liz M Sorenson

Title

Clinic Administrator

Phone

(320) 839-6157

Specialties & licenses 4

Addresses

Other identifiers 5

Locations

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

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228694400000",
    "number": "1265401681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "465 EASTVOLD AVE",
            "city": "ORTONVILLE",
            "state": "MN",
            "postal_code": "562781107",
            "telephone_number": "320-839-6157",
            "fax_number": "320-839-3851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "465 EASTVOLD AVE",
            "city": "ORTONVILLE",
            "state": "MN",
            "postal_code": "562781107",
            "telephone_number": "320-839-6157",
            "fax_number": "320-839-3851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE MEDICAL CENTER, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-16",
        "last_updated": "2008-12-08",
        "status": "A",
        "authorized_official_last_name": "SORENSON",
        "authorized_official_first_name": "LIZ",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "320-839-6157"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "01011119",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN",
            "identifier": "05647NO",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CJ3171",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE OF MINNESOTA",
            "identifier": "106639",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "794447100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Ortonville, MN
• Providers in Ortonville, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2008; 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.